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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (Mo pages per tank),/'lam'_ <br /> TADS/JS 7I P.Q. _ W >% <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ a.AMENDED PERMIT CHANGE OF INFORMATION) ❑ B. TEMPORARY SITE CLOSURE <br /> <`s <br /> (Dhwk om ihm orRH XG/ <br /> ❑3.RENEWAL PERMIT ❑ T. PERMANENTLY CLOSED ON SITE <br /> (SPerJO'rsasan-rorbcal uss oMy) (SpecAy clMnp.-brac.l we only) ❑ B. TANK REMOVED 030 <br /> BUSINESS NAME(Sema as FACILITY NAME w DBA-WIN Business As) FACILITY IO t 1 <br /> gkA R D lie lti re s `�^r <br /> LOCATION WITHIN SITE <br /> I.TANK DESCRIPTION <br /> TANK ID N TANK MANUFACTURER <br /> L.�'C.^'_y"/_fir COMPARTMEIf y.s"ED TANK ❑ Y. o <br /> If'Yaf,wmplata wro papa br earA wmp.rtmonl. <br /> DATE INS�TA"LLED(Y�EEAA'R�NAO) TANK CAPACITY IN2GALLONS NUMBER OF COMPARTMENTS <br /> G _n( V 5- O <br /> ADDITIONAL DESCRIPTION(Forb use WW <br /> 11.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE `y <br /> MOTOR VEHICLE FUEL [I Is REGULAR UNLEADED ,8{s2. LEADED ❑ 5. JET FUEL <br /> (17rmnMd...PMIs Ntm Tyys) 0 l. PREMIUM UNLEADED ❑ 3. DIESEL ❑ S. AVIATION FUEL <br /> ❑ 2. NOWFUEL PETROLEUM 01c MIDGRADE UNLEADED ❑ A GASOHOL 0 OTHER <br /> ❑ 3. CHEMICAL PRODUCT <br /> ❑ A WIZARWIJS WASTE(IrKJudes COMMON NAME @pm HBzaN,s,Mafis.s InwMoypaps) OAS M Prom Hazshlous M.t.dah Inwntary page) <br /> Used Op <br /> 1195 <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK I- SINGLE WALL Cl 3. SINGLE WALL WITH ❑ 5. SINGLE WALL VATR INTERNAL BUDDER SYSTEM <br /> (Ch.ck..Ram.w ❑ 2, DOUBLEWAM EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> D 0. SINGLE WALL IN A VAULT [199. OTHER <br /> TANK MATERIAL-primary tank X, BARE STEEL Cl 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE 095. UNKNOWN <br /> (CMck.m item wry) ❑ 2. STAINLESSSTEEL ❑s. STEELCUDWIFISERGUSS ❑ 8. FRP COMPATIBLE W11 W%METHANOL ❑BB. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-s.cnrMsr7 lank 11 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 8. FRP COMPATIBLE WIIW%METHANOL 095. UNKNOWN <br /> (Checkw Ram on*) ❑ 2. STAINLESS STEEL ❑ ". STEEL CUD WIFIBERGUSS ❑ 9. FRP NON-CORRODIBLE JACKET _ 099. OTHER <br /> REINFORCED PLASTIC(FRP) [1 10. COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LINING 0 1. RUBBER LINED ❑ 3. EPDXYLINING Cl 5. GUM UNING 095. UNKNOVM433 DATE INSTALLED <br /> OR COATING El �p� <br /> 2. ALKYD LINING ❑ I. PHENOLIC LINING rye UNLINED 0B9. OTHER Forbcalum <br /> LhsO om Aom o <br /> OTHER CORROSION DATE INSTALLED <br /> PROTECTION IF APPLICABLE t. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PUBTIL ��`rrryyy�rBS. UNKNOWN 6 <br /> PROTECTION ❑ A,IMPRESSED CURRENT �p 98. OTHER <br /> (Check om Rern wtly) Cl 2. SACRIFICIALANODE '` (Porkcalus .w <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forkrulum ady) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (CMck0th.l.p*) ❑ 1 SPILL CONTAINMENT ❑ 1.ALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ Z. DROP TUBE ❑ 2. BALL FLOAT_ ❑ A. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> N. TANK LEAK DETECTION <br /> IF SINGLE WALL TANK 0thet8IF DOUBLE WALL TANK OR TANK WITH BUDDER(Chack.m Ram <br /> ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING,(MM) ❑ 1. VISUAL(SINGLEWALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ B. VADOSE ZONE ❑ 2. CONTINUOUSINTERSTITIALMONITORING <br /> ❑ 3. CONTINUOUSATG ❑ 7. GROUNDWATER ❑ 3. MANUALMONITORING <br /> ❑ A STATISTICALIWENTORYRECONCILIATION(SIR)♦ ❑ 8. TANKTESTING <br /> BIENNIAL TANK TESTING B9. OTHER hI V Y\ <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(Y Y) p/ ESTIMATED QUANTITY OF SUBSTAN E REMAINING 435 TANK FILLED W1TX INERT MATERIAL? <br /> MAR 2 $ 2001 <br /> ENVIRON"PNT HEALTH FormerlySWRCRFo" <br /> CUPAFORM(area) v PERty 4ERVICES <br />