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..2/29/2006 16:06 2094683e—I EHD AGE 04 <br /> UNIFIED PROGRAM CONSOLIDATED FORM ANK: <br /> PRM: <br /> UNDERGROUND STORA E TANKS - TANK PAGE l H 0 7 FAC:: <br /> (two pages per mnk) <br /> 1 TYPEOEACTION Nata.,F <br /> IDAnY rely hreea) ❑ 11tENEwA11'EKMII' 'PION ❑6 NEN1 SRR CLOSURE <br /> 1 NEW SITE PEAMIT ❑ ❑ 5CHANGS Of <br /> FA N. $PERMANENT DO SITE Q� <br /> 1 <br /> . <br /> � c � 1mx" ❑A TANK REM D � �1�, 1 OIL <br /> nu FACW'(Y MErDEA•Nis,16 or Ad PRN: ^'V� <br /> uA o <br /> LOCAI 10N W17FJTN SITE(DPIimN) rlei <br /> I <br /> PHONE <br /> L TANK DESCRIPTION(A sold Plot Phle wrlh the loution of At UST ry lem InClUdlnl bvgdinps and Iuldmuk3 shill Its wbmitted to the oc3agcaey. <br /> TANK IDN e11 TAN MANl1FACil1REl✓, .yy COMPM'I MENTALIZED TANK ❑Ycs ❑No 44 <br /> . I .Q1iQ i+-•e1/L.J IPYcf'.<onoleu we reNo fa awA<one+Amme <br /> DATE UibT D( O) qF 'fA CAA L436 'OMll'AICTMENTS nT <br /> cS an <br /> ADDITIONAL DESCRIPTION(F>Ird me") m <br /> U.TANK CONTENTS <br /> IANK USE qv PETROL TYPE «o <br /> 1Mrr MOTOR VEHICLE FUEL Ba.REGULAR UNLEADED Cl 2 FADED ❑S.1ET'FUEL <br /> (1c.• as uxpk.r.k.TPe) ❑ Ib.PREMIUMUNLEADED ❑3.imm ❑6.AVIATION PUEL <br /> Cl S NON-FULLPE7KOLEUM ❑ le.MIDORADEUNLA OED ❑ NGASOHOL ❑99.OTHER <br /> ❑ 1,CREMICALPRODUCT COMMON NAME(A,r.m.w«oMw wm. <br /> [3N RA2ARDOUS WASTE 'TPF) <br /> u1 GSN(6aeN Mw.M.w+YL•.wuq PN6e) w) <br /> OeN:n N•NDl) <br /> ❑ 92 UNKNOWN <br /> ID.7A91Y COI 15TRUCTION <br /> TYPE OF TANK B.ISNCLEW'ALL ❑3.SINGLE WALL WITH S.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> 1 EX7EIUOK MEMBRANE I WER <br /> Iema..r•ew aay; ❑93.UNKNOWN <br /> ❑2.DOUB EWALL ❑d.SINGLE WALL IN VAULT ❑ 9P.OTHER <br /> 71MATERIAL•P,,.x .mk .BATHE STEEL ❑ PTRERCLASS/PLASTIC ❑3.CONCRETE ❑93.UNKNOWN ale <br /> 1 IOwk we m.sNr) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD WNIBEGIASS ❑A FRP COMPTTRLE W/I00%METHANOL <br /> 0.ENFORCND PLAS7 (PRP) ❑99,OTHER <br /> TAVXVATERIAL•secondwy unk ❑ I.BARD 97LEL ❑3.FIBERGLAS /PLASTIC ❑S.CONCRETE ❑ 93.UNKNOWN eel <br /> (Ueee..Nen•xy1 ❑ 2.STAINLESS STEEL C3 4.STEEL CLAD W/FIBERGLASS ❑8,In COMPTIBLE W/100%METHANOL <br /> RENFORcm TIC(FRP,) ❑ 10.COATED STEEL ❑ 99.07THER <br /> ❑S,CONCRETE <br /> \ <br /> TMX COURION.LINUYO eeA DATE INSTALLED «1 <br /> V OR COATING ❑ 1•RUBCERLNED ❑).EPDXY LNING ❑ S,GLnSS LINING KNOWN <br /> (CSeae•.a..•.+y) ❑3ALKYO LNINO ❑APRENGLICLNIN ❑6UNLINED 99 OTHER <br /> 1 OTHERCOAAOSION ❑ I MAAMACTURINO CATT/DDICuN DATEMSTALLSD 49 <br /> PROTECTION If APPLICABIS PROTECTION ❑•T FIRERGL D CURRENT <br /> PLASTIC UNKNOWN <br /> ([icY arc+xevM ❑AINPRESSIDCURRENI' ❑990TI{ER <br /> ❑ 2SACAIRCI,\L ANODE liw Faa�nr«t.) <br /> SPILL AND OVEROLL YEARINSTAI.LVIN TYP20"ne 11) AU OVERFILL PROTECT ON EQUIPMENT:YEAKNSTALEEO All <br /> 1 I<NrS vlhen.mtd ❑ 1 SPILL CONTAINMENT /�-- 1:1IALAIM ❑ 9 FILL TUBE SHUT Off VAL' <br /> ❑ 2DROP TUBE N ( ❑ 2BALL ❑ NEXEMPT <br /> ❑ 3STUKER PLAT£ F FLOAT <br /> IV.7ANK LEAK DETECTION(A"iceo da nmiedrR mm-A:■l-NMAsduoe ae:ymq) <br /> TSN WALL TANK IDwdu09wmrbl ell IF OOUSLE WALL TANK OR TANK WITH BLADDER 0, <br /> $MnNVAL TANK OAUO.0(MTO) (CAuA vrciA+e•y9 <br /> 1 VISUAL(EXPOSED PORTION ONLY) ❑ ❑ I VISUAL(SNCLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATO) ❑6VADOS6 ZONE <br /> ❑)CONTINUOUS ATG 07GROUNOWATER ❑2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑e STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING ❑S MANUAL MONITORING <br /> (SW BIENNIAL TANK TESTING ❑9901HU <br /> V,7ANKC10SVREENFOWMATION PERMANENT CLOSUREIN PLACE <br /> ESTIALATLD DATE LUT USED(YR/MO.'DAY) e53 ESTIMATEDQUAF.TITVOF. 'BSTANCEREMAINNG eae TANKFlLLED WITH INERT MATARIAL? ell <br /> ❑Yes ❑No <br /> UPCF(12199 revised) <br />