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ST01� <br /> ✓�.A <br /> tiNFIED PROGRAM CONSOLIDATED FORbt <br /> TANKSi' W� �l0 <br /> UNDERGROUND STORAGE TANKS- TANK PAGE 1 Ky <br /> (Two pages per tank) <br /> Page_of <br /> TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. <br /> (Check one item only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE <br /> (specify,reason) (Specify reason) ® 8.TANK REMOVED <br /> BUSINESS NAME(Same as FACILITY NAh1E or DBA-Doing Business As) 3, FACILITYID: 1' <br /> Hondo Company LLC <br /> LOCATION WITHIN SITE(Optional) 431 <br /> I.TANK DESCRIPTION <br /> (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the localagency.) <br /> TANK ID# 432. TANK MANUFACTURER 433_ COMPARTMENTALIZED TANK ❑Yes ® No 434. <br /> 1 If"Yes,"complete one page for each compartment. <br /> DATE INST LED 43s. TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS 437 <br /> (YEAR/MO) <br /> 500 <br /> ADDITIONAL DESCRIPTION(For local uee only) 438. <br /> IL TANK CONTENTS <br /> TANK USE 439. PETROLEUM TYPE 440. <br /> ® 1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL <br /> of checked,complete Petroleum Type) ❑lb PREMIUM UNLEADED 03. DIESEL 06. AVIATION GAS <br /> ❑ 2. NON-FUEL PETROLEUM ❑lc. MIDGRADE UNLEADED ❑4. GASOHOL ®99.OTHER:_unknown <br /> ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 44L CAS#(@om Hazmdous Materiels Inventory page) 442. <br /> ❑ 4. HAZARDOUS WASTE <br /> (mmudea Used oil) <br /> ❑ 95.UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ®1. SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. <br /> (Check one item only) MEMBRANE LINER ❑95. UNKNOWN <br /> ❑2. DOUBLE WALL [14, SINGLE WALL IN A VAULT ❑99. OTHER <br /> TANK MATERIAL-primary tank 01. BARE STEEL ❑3. FIBERGLASS/PLASTIC 05. CONCRETE 095.UNKNOWN 444. <br /> (Check one item only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: <br /> REINFORCED PLASTICRP W/100%METHANOL <br /> TANK MATERIAL-secondary tank ❑l. BARE STEEL 03. FBERGLASS/PLASTIC 0 <br /> 8. FRP COMPTIBLE W/100%METHANOL 095.UNKNOWN 445. <br /> (Check one item only) [12. STAINLESS STEEL E14. STEEL CLAD W/FB3ERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) ❑10. COATED STEEL <br /> [15. CONCRETE <br /> TANK INTERIOR LINING [11.RUBBER LINED [13.EPDXY LINING LJ 5.GLASS LINING ®95.UNKNOWN 446. DATE INSTALLED 447. <br /> OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING ❑6.UNLINED ❑99.OTHER <br /> Check one item only) <br /> OTHER CORROSION ❑1.MANUFACTURED CATHODIC [13.FIBERGLASS REINFORCED PLASTIC ®95.UNKNOWN 448, DATE INSTALLED 449. <br /> PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER <br /> IfApplicable) ❑2.SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451, 1 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. <br /> (Check all that apply) [11.SPILL CONTAINMENT ❑1.ALARM [13.FILL TUBE SHUT OFF VALVE <br /> [12.DROP TUBE ❑2.BALL FLOAT ®4.EXEMPT <br /> ❑3.STRIKER PLATE <br /> IV.TANK LEAK DETECTION <br /> (A description of the monitoring program shall be submitted to the local agency.) <br /> IF SINGLE WALL TANK 453_ IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. <br /> (Check all that apply) (Check one item only) <br /> ® 1. VISUAL(EXPOSED PORTION ONLY) [15.MANUAL TANK GAUGING(MTG) [11,VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE [12.CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3.CONTINUOUS ATG [17.GROUNDWATER [13.MANUAL MONITORING <br /> [14. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING <br /> (SIR)+BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455' ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? 457' <br /> 1980 0 gallons ❑Yes N No <br /> UPCF hwfwrc-b(1/99)-1/4 www.unidoes.org Rev.02/16M <br />