Laserfiche WebLink
r <br /> UNIFIED PROGRAM CONSOLIDATED FORM �p TA K <br /> AGE TANKS-TANK PAGE <br /> 7 <br /> UNDERGROUND STORAGE '[ (""o pa 'ef `"1 I <br /> 1 Paye <br /> I <br /> S.CHARGE INFORMATION) ❑e.TEMPORARY SITE CLOSURE <br /> © 5I <br /> D 1.NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ T.PERMANENTLY CLOSEO ON 517E <br /> TYPE OF ACTION 8.TANK REMOY^D 470 _ ff <br /> (Cheek*A#"A C* (SPeerFl change-Jorlocal Use CAW - 1 <br /> ❑3.RENEWAL P�RMTC (Spadry reason-tortocal use__A <br /> FACILITY ID 0 �� '�• <br /> BUSIN NALIE(Same as FACILITY NAME <br /> or OBA-OoM9 Business Aa) - �' <br /> 1 43t <br /> LOCATION VYI SITE(0;9 naq <br /> L TANK DESCRIPTION NK ©Yes ❑ No <br /> A K MANUFACTURER n \ COMPARTMEN-yee c o 7Alete one PaSe ter each rpm0arrenL <br /> ` YJ LI'Yes-,cane <br /> TA,VK IO Il 1AvJ�'ihy <br /> NUMBER OF COMPARTMENTS <br /> TAN CAPACITY IN GALL �� Q <br /> DATE INSTAU.ED(YEARIMO) <br /> rs / D D� 6/} <br /> ff ! <br /> App1710NA SCRIPTION(Forloal use CM <br /> IL SANK CONTENTS <br /> 4]2 pETROLEliM TYPE ❑2,LEADED ❑ S.!ET FUEL <br /> TAtEMCL UNLEADED <br /> �/ ❑is REGULAR ❑ B.AVIATION FUEL <br /> MOTOR VEHICLE FUEL DIESEL <br /> �tlmarked Complete Pe''W'm Type) ❑{p, PREMIUM UNLEADED ❑99.OTHER <br /> ❑ <br /> ❑ 2.NON-FUEL PETROLEUM ©ie MtOGRADE UNLEADED 4.GASOHOL CAS a(kom Haraedous Mate+�ats frnen1oryPa9e) <br /> ©].CHEMICAL PRODUCT COMMON NAME(hem Narardous Watadats MventayPa9a) <br /> ©4_ HLAZRQOUS WASTE(lndudes , <br /> Used 00) <br /> IB,TANK CONSTRUCTION <br /> 13[3 ]..SINGLE yyALLVNTH 5.SINGLE WALLIAITH INTERNAL BLADQER SYSTM <br /> E <br /> TYPE OF TANK ❑ 1. SINGLE WALL EXTERIOR MEMBRANE LINER ❑95.4JWJK WN <br /> (Chock one Ilam erdy) 2. DOUBLE WALL '(34, StNGLE WALL INA VAULT [ gg.OTHER <br /> (( R. ❑ 5. CONCRETE THANOL ❑45. UNKNOV+`I <br /> ❑ 3. FIBERGLASSIPLAST$C 099. OTHER__� <br /> TANK MATERIAL-Ph1e wk i. BARE STEEL ❑ a'FRPCOMPATIBLE'AYtCO'.MESTAINLESS STEEL C3�_ STEEL CLADy1oFIBERGIASS <br /> ([heck end dean oM9 REINFORCED PLASTIC PI ❑95.UNKNOWN <br /> TANK MATERIAL-setusCary tart& I. BARE STEEL <br /> 0 3 FIBERGLASS t PLASTIC D B. FRP COMPATIBLE tiwtoax METHANOL 13 99.OTHER_-� <br /> ❑ a. STEEL CLAD W/FIBERGLA55 [39.FRP tIONd36RRO01BLE.IACK <br /> ET <br /> (Check On&item en)yl Cl 2. STAINLESS STEEL REINFORCED PLASTIC{FRP) Q t0.COATED STEEL 1 <br /> ❑ 5 CONCRETE DATE INSTALLED <br /> ❑ 3. EPDXY UM14G 05.GLASS UNiNG. ❑45.UWNOVVN433 <br /> TANK INTERIOR UpanG ❑ 1. RUeBERUMED B.UNLINED ❑99.OTHER .,(ForJec"' GnF <br /> OR COATING ❑ 7. ALKYD LINING [34. PHENOLIC LINING OA7E INSTALLED <br /> © N1D�om 634 <br /> k°^°item ❑ 3. FIB95. U <br /> ERGLASS REINFORCED PLASTIC _ <br /> OTHER CORROSION ❑ 1.MANUFACTUREO CATHODIC [a 99.OTHER .- (ForJocat us*wW 1 <br /> PROTECTtONIFAPPUCA3'e PROTECTION ❑ 4. IMPRESSEQCURRENT <br /> (Check Cne idem bAw 2_ SACRIFICIAL ANODE - TYPE(Porlocal use WW OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> YEAR INSTALLED <br /> SPILL AND OVERFILL ❑S. FILL TUBE SHUT OFF VALVE <br /> 1.ALARM <br /> (Cft*C11 an that apply) ❑ 1. SPILL CONTAINMENT ❑© 4.EXEMPT 2.BALL FLOAT <br /> ❑ 2. DROP TUBE -----�--� - <br /> 3. STRIKER PLATE ....._ _ - .. . <br /> IV.TANKLEARDETECTIOt( .'. <br /> - IF pOU6l.E WALL,TANK OR TANKYATH BLADDER(Check ene Rem <br /> IF SINGLE WALL TANK(Check RNMBts 1: ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) ' <br /> EO PORTION ONLY) © 5, MANUALTANK GAUGING(ATG) LMONL70R1NG <br /> ❑ 1. ytSUAL{EXPOS © g. VADO5EZONE � 2. gONTINL10US1NTERST1TtA <br /> Q 2. AUTOMATIC TA14K GAUGING(ATG) ❑ T. VADOSE ZON ER ❑3. MOML MONITORING <br /> ❑3. CONTOIUOUSATG ❑8. TANKTESTING <br /> ❑ 4. STATISTICALINvS 4TORY RECONCILWTION(SIR)• 99. OTHER <br /> BIENNIAL TANK TESTING <br /> V.TANK CLOSURE INP)R51A7tON J AIMING EN`f CLOSURE 114,�CTANK FILLED WITH INERT MATERIAL? <br /> USEQ gnµO1DAY) ESTIMATED OUANTLTY OF SUBSTANCE <br /> REAAINING <br /> ESTIMATE�rCA aUons ©Yes ❑No- . <br /> [7 <br /> FOMWY S <br /> L <br />