BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

i UN'D PROGRAM CONSOLIDATED FORM TANK: �mmot, 14111111A PR 0: UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC IN (two pages per lank) TYPEOFACrION I NEW SITE PERMIT ❑ a A51ENDLD PERMIT E] 5CIIANGEOFISFORMAHON ❑ 6TEMPORARY SITE CLOSURE Pagc2 31 (Cl,xk only im...y) ❑ 7PERMANENTLYC NSITE ❑ ]RENEWAL PERMIT ( °ryx °0ej�0 °la Y' (5p«pry rwson.(orlowl use o�Jy) ryreCJl' +a,. 'h,� ❑STANK REMOVED BUSINESSNAME(s,meta CILITY NAME.,DBA-Doan Bmiar.M) FACILITY ID: PR p; I �� LOCA ION ITHIN SITE(optvnp 4n PHONE I.TANK DESCRIPTION(A scaled plot plan with We location of the UST System including buildings and landmarks shall be subrldtted to the local age my.) TANK IDN 432 TANK MANUFACTURER 45J COMPARTMENTALIZED TANK Uh l✓•70W r) El Yes ❑No u4 / IrUMBEROFCwaar RT r«P,mnml. DAAF STAL D( EAR/MO) 455 TANK CAPACITY IN GALLONS 456 NUMBER OF COMPARTMENTS 2 goo u7 o.Nr1 nKnaon ADDITIONAL DESCRIPTION(F« n TANK USE 459 PETROLEUM TYPE 11.TANK CONTENTS ❑ I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5JET FUEL (Ilm.r4�c.�rylme p.tmlwn Tyw) ❑ Ib.PREMIUM UNLEADED ❑3.DIESEL 1 ❑ 2.NON-FUEL PETROLEUM ❑ fi.AVIATION FUEL ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL 99.OTHER ❑I.CHEMICAL PRODUCE ❑4 HAZARDOUS WASTE COMMON NAME If.Haar.M.Isd.H l�mmlmrwaa) 441 CASH(rmx.,armm M.Ied,x 1-tauxypage) uz p«Iwm u.m aD VA 95.UNKNOWN A.� 111.TA CONSTRUCTION I I1� TYPE OF TANK 1Lt I.SINGLE WALL ❑3.SINGLE WALL W ITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM u5 l01` (Cock o«ism only) EXTERIOR MEMBRANE LINER [145.UNKNOWN E] 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (cn«t m.imu miry) El2.STAINLESS STEEL ❑ STEEL CLAD WNIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary lank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTICS.CONCRETE (Ch kmeimnonly) ❑ 2.STAINLESS STEEL ❑ ❑95.UNKNOWN 445 ❑4.STEFL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(I") ❑ 10.COATED STEEL ❑".OTHER ❑ 5-CONCRETE TANK INTERIOR LINING OR COATING ❑ 1.RUBBER LINED ❑ 3,EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 449 (Ch«k my nen mly) ❑ 2ALKYD LINING ❑4PHENOLIC LINING s�6 UNLINED ❑".OTHER OTHER (F«local u.mly) PROTECTION CORROSION IF P ❑ I MANUFACTURING CATHODIC PROTECKmwy)APPLICABLE PROTECTION ❑3 FIBERGLASS REINFORCED PLASTIC 95 UNKNOWN us DATE INSTALLED u9 (c6sck°«im.mYl ❑4IMPRESSED CURRENT ❑ 2SACRIFICIAL ANODE ❑ ""OTHER SPILL AND OVERFILL (Fm local mcalF/) YFARINSTALLB50 TYPE(Za--only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Ck«k dl N.uppH) [IISPILL CONTAINMENT ❑ 2DROP TUBE ❑ IALARM ❑ 3 FILL TUBE SHUT OFF VAL' ❑ 3 STRIKER PLATE ❑ 2 BALL ❑ 4 EXEMPT FLOAT IV.TANK LEAK DETECTION(A dmmiptimr or lk.nnnnattm pmmvn s606,.ubmiNd m the l«d,nenyJ IF SINGLE WALL TANK(Clnak.nnm,ppry) 455 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL'TANK GAUGING(M'EG) R1.k m,:ixm mdy) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6VADOSE TONE ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ❑2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING (SIR)BIENNIAL TANK TESTING 0 9 OTHER ❑3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(VR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK PILLED WITH INERT MATERIAL? 459 ❑ Yes ❑No UPCF(12/99 revised)