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Ak P UNIFIED PROGRAM CONSOLIDATED Fd M q l2 3 f!3 UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYPE OF ACTION (Check one item only. For an UST pemaAL PERMII'Or rpnoval,complete only this O°5.CHANGE OF INFORMATION belo ❑ I.NEW PERMIT ❑ 4306 ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE1DATE EXISTING US®DISCO REQ 9/1/2013 DATE UST PERMANENTLY CLOSED: I. FACILITY INFORMATION $ 1 , FACILITY ID#(Agency Use Only) BUSINESS NAME(Sae as FACILITY NAME or DBA-Doing Business As) m Levand Family Trust0 103CTCY BUSINESS SITE ADDRESS Trac 47 East Eleventh Street II.TANK DESCRIPTION 432 TANK MANUFACTURER 033 TANK CONFIGURATION: THIS TANK IS TANK 1D# I 19 1.A STAND-ALONE TANK unknown �� [12.ONE IN A COMPARTMENTED IIN77'. C Ide ane formefim mthe writ. 437 435 TANK CAPACITY M GALLONS 436 NUMBER OF COMPARTMENTS 11' THE UNIT DATE UST SYSTEM INSTALLED 1 unknown SOO IIL TANK USEAND CONTENTS 439 ❑ Ie TANKUSE ❑ Ia MOTOR VEHICLE FUELING [IIb.MARINAFUELING .AVIATION FUELING ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE u.i.dn Uud oil) 0 5. _RGENCy GENERATOR FUEL IHSC§252e1.5(c))99 OTHER (Sp"if`Y� 439. ❑ 6.OTHER GENERATOR FUEL ® 95.UNKNOWN *11)CONTENTS PETROLEUM: ❑ III REGULAR UNLEADED ❑ Ie.MIDGRADEUNLEADED E] 16.PREhIUM UNLEADED ❑ 3.DIESEL ❑ 5.JET FUEL (1 6.AVIATION GAS 440, ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): unknown petroleum NON-PETROLEUM:❑ 7.USED OIL ❑ --.-..--40L bbdb ❑ 11.OTHER NON-PETROLEUM(S ify): IV. TANK CONSTRUCTION 44; TYPE OF TANK ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ® 95.iNKNOWN 414 PRIMARY CONTAINMENT ❑ I.STEEL ❑ 3.Ff ,LASS [-I ...T1llI LBLADDER µy ❑ 7.STEEL+INTERNAL LINING ® 95.UNKNOWN [399.OTHER IS i 44s SECOtNDARY CONTAINMENT EI I.STEEL El 3.FIBERGLASS [1 6.EXTERIOR MEMBRANE LINER E] 7.JACKETED w5• ❑ 90.NONE [K 95.UNKNOWN [199.OTTIER(S ify: 451 OVERFILL PREVENTION 3.FILL TUBE SHUT-OFF VALVE o i TESIEAL ALARMSE4ANKMETRQUIREMENTS FOR XEMFTION FROM OvERFTLL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION 460 PIPING CONSTRUCTION ❑1.SINGLE.WALLED [12.DOUBLE-WALLED ®99.OTTER ase SYSTEM TYPE EI 1.PRESSURE LI2.GRAVITY ❑ 3.CONVENn)NAL SUCTION ❑ 4.SAFE SUCTION[z3 CCR§263d(eKlp 464 PRIMARY CONTAINMENT ❑ I.STEEL _j4.FIBERGLASS ❑ 8.FLEXIBLE [1 l0.RIGID PLASTIC bdb ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Slamify): I0.RIGID PLASTIC 4sab SECONDARY CONTA1NIsME.NT ❑ 1.STEEL ❑ 4.FIBERGLASS 0 8.FLEXIBLE ❑ 461c ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4614 PIPING(RJRBINE CONTAINMENT SUMP TYPE ❑ I.SINGLE WALL [3 2.DOUBLE WALL [1 90.NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION a4ae VENT PRIMARY CONI mNMENT [011.STEEL [014.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 30.14 19 99.OTHER(Specify) bdb 464f VENT SECONDARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS 10.RIGIDPLASTIC ❑ 90.NONE ® 99.OTHER(SPdfy e ) 46113 0448 VR PRIMARY CONTAINAMEM ST ❑ I. EEL 01 4.-FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ® 99.0ER(Spe<ifY) bw 1 464h VR SECONDARY CUN I INSMENT' ❑ 1.STEEL ❑ 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE ® 99.OTHER(Specify) aMht VENT PIP TRANSITION SUMP TYPE ❑ 1.SMGLE WALL ❑ 2.DOUBLE WALL [I 90.NONE 464i RISER PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ® 99.OTHER(Specify) 464.1 464k IO.RIGID PLASTIC 90.N99.OTHER(Specify) 460kl RISER SECONDARY CONTAINMENT I.STEEL 4.FIBERGLASS ONE FILL COMPONENTS INSTALLED ❑ I.SPILL BUCKET 3.STRIKER PLATFIBOTTOM PROTECTOR ❑ d.CONTAINMENT S451. UMP VII.UNDER DISPENSER CONTAINMENT NDC) 469. CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE W ALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469b-c CONSTRUCTION MATERIAL ® 1's VIII. CON RGLASS IPROTECTION ❑ GTt�R s t ) 448. STEEL COMPONENT PROTECTION [32.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION IX. APPLICANT SIGNATURE CERTIFICATION:I certify that thh UST system[S compatible with the harardous substance stored and that the information provided herein is true,accurstg, and it full mm liaoce with 1 al requirements. 474 APPLICANT SIGNATURE DATE 9/20/2013 NAME(print) Roert Marty Trust 472 APPLICANT 611' APPLICANT TITLE Agent for L¢Vend Property �^ Rev.(12200'q UPCF UST-B-1l2