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I <br /> UNIFIED PROGRAMCONSOLIOA:Eo M <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE I <br /> tM pages vier rank) +I, <br /> \� Page of <br /> TYPE OF ACTION ❑1.ANEW SITE PERMIT l ;. AMENDED PERMIT Cl S.CHANGE OF INFORMATION) ❑ J. cMPORARY SITE CLOSURE <br /> (Chock one dem onfy) ❑ 7 -ERMANENTLY CLOSED ON SITE <br /> ❑3.RENEWAL PERMIT -Seecrfyraesgn-;'w--cal useonfy) (Specrtvchange-'grlocal-sill omy} ❑ d. -ANK REMOVED a30 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA•OoIn4 3usmess Asl r`ACILt1Y ID <br /> MAGE ft C1 <br /> U-- <br /> LOCATION WITHIN SITE(Opwriat) 431 <br /> I.TANK DESCRIPTION r' <br /> TANK 10 7 TANK MANU=AER COMPARTMENTALiMD TANK ..Ps 14.It-es'.=Moiete me nage for tem comganmenc ` <br /> DATE iNSTALLFO(YEAR/MO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> g g zc)Q <br /> ADDITIONAL DESCRIPTIO tForlacar use onM <br /> IL TANK CONTENTS <br /> TANK USE 432 a 7ROLEIM TYPE I <br /> ' MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED Cl 2 LEADED Cl s. ,r--7 FUEL <br /> (N marked.Comfkere Peagleum Type) ❑lti. ?REMI UNLEADED x3. DIESEL ❑ S. AVIATION FUEL <br /> ❑ Z. `ION-FUEL PETROLEUM ❑.� MIOGRADE UNLEADED ❑ :1 :GASOHOL I ❑99. OTHER <br /> ❑ 3. CHEMICAL PRODUCTj CAS 8 fhelm HaZarnaus MWendIS+nventory Rage) <br /> ❑ 4. HAZARDOUS WASTE(InCudas COMMON NAME Ifrom NazarrlOus Alatenais frtuanfory page) i <br /> Used O)f1 <br /> -i? <br /> RI.TANK CONSTRUCTION <br /> TYPE]F TANK Cl I, SINGLE'NALL lJl 3. SINGLE WALL'MTH ❑ S. SINGLE WALL'MTH INTERNAL BLADDER SYSTEM <br /> (Check one Item only) 2. DOUBLE WALL -:MR10R MEMBRANE LINER ❑95. UNKNOWN <br /> ❑ a. SINGLE`NALLINAVAULT ❑99. OTHER <br /> TANK MATERIAL-onmary tan% I. BARE STcEi_ ❑ 1. FIBERGLASS I PLASTIC ElS. CONCRETE I❑95. 'JNKNC'NN <br /> (Cllecx one Item only) ❑ 2. 3TAI14LESS STEEL I❑ t. STEEL CLAD WIFIBERGLASS ❑ 3. FRP COMPATEBLE^A1100%METHANOL F❑99, OTHER <br /> REINFORCED PLaSTtC IFRPI <br /> TANK MATERIAL-seconcary tanK C] BARE STEEL. 3. FIBERGLASS i PLASTIC ❑ a. FRP CCMPAT18LE W100%METHANOL <br /> v 95. UNKNOWN <br /> (Checx one Item only) ❑ 2. STS AINLESS ST'cEL ':.! A. STEEL CWO'MFIBERGWSS ❑ 9. =RP NON-CORRODIBLE JAGCEr r 99. OTHER <br /> REINFORCED PLASTIC,FRP) ❑10. COATED STEEL <br /> ❑ 5. CONCRETE <br /> DA.Ic:NSTALI_ED <br /> TANK INTERIOR LINING <br /> Cl❑ !. RUBBER LINED ClU 3. EPO%Y LINING \❑ 5. v'LASS LINING ❑95. UNKNO'+>.'N433 <br /> OR COATING I <br /> 13 2. ALKYD LINING ❑ ;- PHENOLIC LINING 1U� 3. JNtJNED ❑99. OTHER <br /> 7arlocdt use anN! <br /> {Checx one Ilem onfv) _ DATE INSTALLED <br /> OTHER CORROSION ❑ 1. .MANUFACTURED CATHOOIC IU 3. f•IBERGLASS REINFORCED PLASTIC Cl 95. UNKNOWN 434 <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ s. IMPRESSED CURRENT ❑99. OTHER d <br /> I'Fgrlocal use amyl <br /> tchocx one dem only) ClZ SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEAR INSTAL LED TYPE(For local use onto OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Check au that appy) I SPILL CONTAINMENT ❑ 1. ALARM ❑ 3. ?ILL TUBE SHUT CFF vALVE <br /> I <br /> 2 DROP TUBE Cl 2 3ALL FLOAT Cl 4, EXEMPT I <br /> 3. STRIKER PLATE <br /> IV. TANK LEAK DETECTION <br /> I -IF SINGLE WALL TANK lCheCk au that aDOM: 1 I IF DOUBLE WALL TANK OR TANK WITH SLADDHR(Checx ane dem ontv): <br /> ❑ <br /> T. VISUAL(EXPOSED PORTION ONLY) 0 S. .MANUAL TANK GAUGING(MTGI Cl 1. VISUAL(SINGLE`NALL IN VAULT ONLY) <br /> ❑ 2.. AUTOMATIC TANK GAUGING(ATGI ❑ 8. VADOSE ZONE - 2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 3. CONTINUOUSATG Cl 7_ 'sRCUNDWATER ❑ 3. '.MANUALMCMTORING <br /> Cl + STATISTICAL INVENTORY RECONCIW4TION(SIRI• ❑ S. TANKTESTING <br /> BIENNIAL TANK TESTING (;99 OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE _ <br /> ESTIMATED DATE LAST USED(YRfMOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? i <br /> )aoanl ❑Yes ❑No <br /> I <br /> CUPAFORM(4/99) 0 ForMerty SWRCS Falco 8 <br />