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LTfIFIED PROGRAM CONSOLIDATED FOR. TANKS <br /> =UNDERGROUND STORAGE TANKS •TANK PAGE 1 <br /> (Mv Pages Per tank) <br /> Pape _ gf <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT 13 4.AMENDED PERMIT . CHANGE OF INFORMATION) 08.TEMPORARY SITE CLOSURE <br /> TYPE <br /> TDna dem on1Y1 ❑ T. PERMANENTLY CLOSED ON SITE <br /> ❑3.RENEWAL PERMIT ($pecilyna+on-xarmlusa oMy) (SpaafYCMrge-brlocN u4e gnlN ❑ 8. TANK REMOVED 439 <br /> BUSINESS NAME(Same u FACILITY NAME or DBA-Dunt BwkMsa As) FACILT'ID• 1 <br /> LOCAMONYaRMNiCIii 400tl oLndreesl C K (. �^ <br /> I.TANK DESCRIPTION <br /> TANK ID n.1610 <br /> ANK MANUFACTURER COMPARTMENTALIZED TANK 0 Yaa 0 No <br /> I�O 1DATE IN ALLED(YEARIMO) ANK CAPACITY IN GALLONSUMBEROFCOMPARTMENTS <br /> ADDITIONAL DESCRIPTION(ForbcM ua <br /> It.TANK CONTENTS <br /> TANKUSE 432 PETROLEUM TYPE <br /> ft. MOTOR VEHICLE FUEL 13 1.. REGULAR UNLEADED 0❑I2. LEADED ❑ 5. JET FUEL <br /> zz rompbM PaBmYum Type) 01a. PREMIUM UNLEADED 0.i. NEBEL 0 8. AVIATION FUEL <br /> ❑ 2. NON-FUELPETROLEUM 01c. MIDGRADE UNLEADED ❑ C GASOHOL ON OTHER <br /> ❑ 3. CHEMICALPRODUCTCCASa(M1om Hazallou+kMMnaN lnveMorypape) <br /> 04. HAZARDOUS WASTE(IrWude+ OMMON NAME fhom MaxerHou+Maferiek lnvsnlorypape) <br /> UW Oip <br /> 95 UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK 1 SINGLE WALL 0 3. SINGLE WALL WITH 0 5. SINGLE WALL WITH INTERNAL BUDDER SYSTEM <br /> (CAack ons dem only) Ida. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> 0 4. SINGLE WALL IN A VAULT 0 99. OTHER <br /> TANK MATERIAL-P ary Wa 0 1 BARE STEEL 0 3. FIBERGLASSIPUSTIC ❑ 5. CONCRETE 095. UNKNOWN <br /> (CM1eckam dam oNyJ 02. STAINLESS STEEL 04. STEEL CUD WIFIBERGUSS 08. FRP COMPATIBLE W11W%METHANOL ❑99. OTHER <br /> REINFORCED PLASTIC(FRP <br /> TANK MATERIAL-wronwryW 0 1 BARE STEEL 0 3. FIBERGLASS I PLASTIC 0 8. FRP COMPATIBLE WI199%METHANOL 095. UNKNOWN <br /> (C kiwwdemgnly) 0 2. STAINLESS STEEL 0 4. STEELCLADWIFIBERGLASS 0 9. FRP NON-CORRODIBLE JACKET 089. OTHER <br /> REINFORCED PLASTIC(FRP) [110 COATED STEEL <br /> Cl 5. CONCRETE <br /> TANK INTERIOR LINING 0 1. RUBBER LINED 0 3. EPDXY LINING 0 5. GLASS LINING 095. UNKNCNVN 9 DATE INSTALLED <br /> OR COATING <br /> ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ B. UNLINED 0 9. OTHER fFvMCN u+ao <br /> rdo <br /> CMck ons item an <br /> OTHERCORROSION 1 MANUFACTURED CATHODIC 0 3. FIBERGLASS REINFORCED PLASTIC 095. UNKNOWN 431 DATE INSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 4. IMPRESSED CURRENT 099. OTHER (frorbcal v+s oMy) <br /> (Ckeck oM asm onM ❑ 2. SACRIFICIAL ANODE <br /> SPILLANDOVERFILL YEAR INSTALLED TYPE(Fmb usa gMy) OVERFILL PROTECTION EQUIPMENT'.YEAR INSTALLED <br /> (Cmcx allMf applYl 0 1 SPILL CONTAINMENT 0 1,ALARM 0 3. FILL TUBE SHUT OFF VALVE <br /> 0 1. DROPTUBE 0 2, BALL FLOAT 0 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> `IV.TANK LEAK IF SINGLE WALLTANK ektMta IF DOABLE WALL TANK OR TANK WITH BUDDER ICMck ane item Dory: <br /> 0 1. VISUAL(EXPOSEDPORTION ONLY) 0 S MANUAL TANK GAUGING(MTG) 0- 1. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> 0 2. AUTOMATIC TANK GAUGING(ATG) 0 8. VADOSEZONE OLV2. CONTINUOUS INTERSTITIAL MONITORING <br /> 0 3. CONTINUOUSATG 0 T. GROUNDWATER 0 3. MANUALMONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR) 0 S. TANKTESTING <br /> BIENNIAL TANK TESTING - 0W. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE UST USED(YMUDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? <br /> gallons 0 Yes 0 No <br /> CUPAFORM(4/99) Formerly SVJRCB Form 8 <br />