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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) <br /> �PF ACTION (Check one nem only. F'or an UST pclmanent closure or remval <br /> o ,complete only this sectIV,ion and Sections 1,11,III, and IX <br /> 6eloW1 "'' <br /> NEW PERMIT R RENEWAL PLRMI I- ❑ S CHANGE OF 1NFORh1AT1ON <br /> 6.TFMPORARY USTCLOSURE 7.USI'I'I'.RMANI-NTCLOSUREON S1'1'E Ej S.UST REMOVAL <br /> DAIT USIPERMANENTLY CLOSED: 410 I DA IE EXISTING UST DISCOVERFD. J�0M1 <br /> 1. FACILITY INFORMATION <br /> FACILITY 11)k(Agency the 00) <br /> BUSINESS NAME(same as FACILITY NAME m DBA-Doing Business As) t" 1 <br /> EAST HARNEY ARCO <br /> BURINFSSSITEADDRLSg --- --- 103 CITY IN <br /> 255 E.HARNEY LANE LODI <br /> IL TANK DESCRIPTION <br /> TANKID# +'0 TANK MANUFAC'R:li)R a- TANKCONFIGUR.11'IOV; IIRS'TANKIS "+ <br /> Ml ASTANI-Al mr.TANK <br /> 1 XERXES ❑2.ONE IN A CO%IPARi MENTEU L <br /> C. Orae ax5n w'hn unun the vs, <br /> DATE:UST SYSTEMINS'1'ALLEU +" TANK CAPACITY IN UALIONS 416 NGXIHER OF COMPARIAILNTS IN IF UNIT +31 <br /> TBD 25,000 1 <br /> Ill.TANK USE AND CONTENTS <br /> TANK USE E I&MOTOR VEHICLE FUHANG ❑ Ih.N1.ARINAELELING ❑ Ic AVIATIO IFLINO aro <br /> • (] #Clat:mICAL PRODLCT STORAGE ❑4.HAZARDOUS W'a51'li(IMh Uv01I ❑ TEMERG CYGENERATORFLIEL1tiscg252at M,)I <br /> pa.UIHERGENERATORFUEL [193.UNKNO%%' 099.OTH is i )' +14i <br /> CONTENTS PETROLEUM' Ia.RI:GCI_AR UNLEADED [3Ic.UIDGRADEUNLEADED ❑ lb.P MIC UNLEADIA) °J <br /> ❑ 3.DIESEL ❑ 3 )ITTCEI, ❑G -IATION GAS <br /> ❑ B.PETROLEUMBLENDFCFi. ❑9.OTIII:RP£TROLEUNI (4 i 44-a <br /> NON-PEDROLF0-7 Tum-D OIL ❑ 10 FTHANOI <br /> ❑ ILOTHER NOS-PETROLEU\IIS Ni a'c's <br /> IV. TANK CONSTRUCTION <br /> TYPE OF TANK ❑ LSINGLE WALL. 2.MEAUX WALL ❑ 93.LUNKNOAN <br /> PRDIARYCOSTAINMFNT ❑ LSILF.L 3.FIBERGI ASS ❑ 6,IN'DRNAI.IlL DER +++ <br /> ❑ 7.STFFL,INTTRNAl.L1.NINO ❑ 93,UNKNOWN ❑ M.OTIIFR 15 .Gl +++. <br /> SECONDARY CON'rAIN\IEN I' ❑ LSTEEL. 3.1`II4FRG1:\tiff ❑ 6.F:X'TI-.RII')R IEN761(ANEIINf.R ❑ ' JACKHM O+ <br /> ❑ 90.NONP. Q 95.UNKNOWN [191)OTf1ERih I. ++`` <br /> (VM ILL PREVENTION 1AUDIIIII(AVISUALALARNIS = 2."ALL IwAT b.FILLTI:OF:SuIa-(eFN'AL\'1: +`= <br /> ❑ 4.TANKNIE£TS REQUIREMENTS FOR EXINIPTION I'RVI OVERT ILL PREVEN I ION EQUIPMENI <br /> V. PRODUCT I WASTE PIPI CONSTRUCTION <br /> PIPINfl CONSTKUCTION ❑1.SINGLE•WALLEO 0, IXJUBLE-W'.%LLED99.OTHER ren <br /> SYSTFAIT'PI[ I.PRESSURE ❑ TOR AN ITY ❑ CONVENTIONAL SUCTIOS ❑ 4.SAFE.SUCTION I:I CFR I)61NsA3d 454 <br /> PRIMARY CONTAIN\H'NT ❑ I SME-L-0 4.FIBERGLASS 4q F).FXIRLE ❑ 10 RIGID PLASTIC R4 <br /> [I 90.NONE [193.UNKNOWN 99.0111E%Pmts) +e+. <br /> SPI-ONDARY CON I',\IN'NIFNT Q I.STEEL. 0 a 1151:14GLASS 6.FLEXIBLE ❑ H1 RIGIDPIM-11C <br /> ❑ % NONE ❑ 93,1:9KNOW'N ❑W.OTHER IS `ify'): ao,: <br /> PPNG'TURBINE CONI"AINMEN'I"SCAIP'I YPY ❑ 1 SINGLEWA 2.DOUBLE.WAI.I. ❑ 'Mi.NONE n.ti <br /> VI.VENT,VAPOR RECOVERY(VR) ND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENTPRIMARYCO\IAiNNIEN7 ❑ 1.STEEL 4FIIlERC.A55 IO.RIGID PLASTIC ❑9o.NONP wOTIIIA(SpxiF) +6+e <br /> • dwa I <br /> VENTSECONDAR) (.'O.N'I':MNMLN'I' I.STEEL 0 4.Fl11 <br /> GLASS MRIOIDPLASTIC 90,NONE [IW OT11VIt6fwif)) 4tdf <br /> 4wf1 <br /> \'R PRINIARY CONTAINW NT I.STEEL. N 4,Fi ERGLASS U 10.RICII)PLASI'LC 90.NONE ❑ 90 OTIT R 15prcA) +G+P <br /> u.1 I <br /> VRMOOXUARY CONTAINMENT I STUT1. 4 "LBERGLASS ❑ ITI.RIGIIIPLA5'rw LI 'xl NONF ❑ 99.OTHF.RiSptci()) +++h <br /> as+hl <br /> VENT PIPiN(3 TRANS[INION S USIP TYPE 0 1SINGI.1:W'Ai .J 2.DOUBLE WALL W NONE �. 4". <br /> RISERT'RIStARYCOSTATWT:NT LSTEEL 4,FIBERGLASS 10.RIGID PLASTIC ❑ A'1 NONE ❑ 99.O'OIFR lspmdy) +al <br /> 9 I <br /> RISER SECONDARY CONLMNMER'T LSTEEL 4 FIRIdRFI AS10.RIGID PLASTIC ❑ 90.NON1: 99.1)T11P:1t fSpcaf)1 ann <br /> +N+I <br /> Flit I-omm)NENTSINSTALIAD 1,SPILL 'CKET 3.STRIKER PLA'II'l1iUIlUN1('ROTECfOR 4CONTAINMuxi-SIOIP <br /> VI .UNDER DISPENSER CONTAINMENT(UDC) <br /> L'ONSTRUCTIONT'PF ❑ 1.SI LF.WALL 2.DOUBT N%V1 ❑ 3.NO DISPENSERS ❑ 90 NON]. +"`+ <br /> CONSTRUCTION MATERIAL I. EEL 4.FIREKUI.,\55 U 10.RIGIDPI.AN I It Ll 99.OTIIFR IS -i1 <br /> Vlll. CORROSION PROTECTION <br /> STITI,('t6B'ONENT PROTECTION 13 2 SACRIFICIAL ANODIIS) L14.IMPR ESSED CURR ENT' ❑ 61SOLA11ON "a <br /> IX. APPLICANT SIGNATURE <br /> CER'1"14ICATION: I terilly that this I.Sf sysleal If compatible xith the hazardous substance stored mad that the Infortnalon pro,tried bercifisq,%.accurate, <br /> and in full compliance With Itital rtgairenneal.t. <br /> i1• <br /> APPLICANT SIGNATURE DATE <br /> APPICANT NAME a11' <br /> LAPPLICANTTITLF. <br /> J s 2 177 <br /> UMJF UST-8•U2 Rev,(IIT WI <br />