Laserfiche WebLink
. bto, o\ <br /> UNIFIED PRO G RAM C ONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 TANKS <br /> (Aro page.p- t ) <br /> Paq• _ m <br /> TYPEOFACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION) ❑ B. TEMPORARY SITE CPace <br /> (CMck ane dam any) <br /> RENEWAL PERMIT (Specfj nasan-brlaoluse on ❑ 7. PERMANENTLY CLOSED ON SITE <br /> yl (Speuy pAanga-bnxM vas only) ❑ 5. TANK REMOVED 4]0 <br /> BUSINESS NAME(Same as FACILITY NAME of DBA-Daln9 Business As) FACILITY 10 a <br /> W6►.� G 7(0 <br /> 0-751? <br /> LOCATION <br /> ' <br /> LOCATION VATKw SITE N;roan u <br /> (L�,I E lli C 1_K (t�- W l C"F �I$ o <br /> I. <br /> TANK 10 TANK MANUFACTURER TANK DESCRIPTION <br /> yCOMPARTMENTALI2EO TANK Y. ❑ NP <br /> 1a'f ,3 '�(�q4� Ir-Yes-,cvmplet•one pate kr eatlt mmpar:,nent. <br /> DATE INSTALLED(YEARNO) TANK CAPACITY INGALLONS NUMBER OF COMPARTM ENTS <br /> 3 (0=0 2 <br /> ADOITIONAL DESC TION(PorAx •pNy) <br /> U.TANK CONTENTS <br /> TANKUSE 432 PETROLEUM TYPE <br /> f. MOTOR VEHICLE FUEL Cl 1. REGULAR UNLEADED ❑ 2.LEADED ❑ 5. JET FUEL <br /> (IfmadM,apmpbb Pa:m4um Type) ❑P 'REMIUM UNLEADED �Y/ <br /> ]. DIESEL ❑ 8. AVIATION FUEL <br /> ❑ 2. NON-FUEL PETROLEUM ! ,c. MIOGRAOE UNLEAOEO ❑ 4.GASOHOL 1199, OTHER <br /> ❑ ]. CHEMICAL PROCUCT <br /> ❑ 4. HAZARDOUS WASTE(bclod a COMMON NAME(ft.HaavBam Mahnala ln.enfary page) r CAS 0(eam Nuallous Maunafa lnwnlory page) <br /> Uses,Oq <br /> Ll9s UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑/p SINGLE WALL ❑ 3, SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLAOOER SYSTEM <br /> (CAaca one ibm any) Ly 2. OGUBLEWALL EXTERIOR MEMBRANE LINER 0S. UNKNOWN <br /> �❑ 4. SINGLE WALL IN A VAULT <br /> 1199. OTHER <br /> TANK MATERIAL pm:arf urA ❑ ] Fl 9 ERGLASSIPLASTIC ❑ 5. CONCRETE 1195. UNKNOWN <br /> (G¢k ens ifa,n oNy) Cl 2. STAINLESSSTEEL A STEEL CLAO WFISERGLASS ❑ 8. FRP COMPATIBLE WI100%METHANOL 099. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL.sac aq un4 ❑❑ 33 FIBERGLASS/PLASTIC ❑ 8 FRP COMPATIBLE WiIW%METHANOL 093. UNKNOWN <br /> (CMc4Pnaifempnw ❑ 2. STAINLESS STEEL V<-STEEL CLAD WIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) 1110. COATED STEEL <br /> ❑ 5 CONCRETE <br /> TANK INTERIOR LINING ❑ 1. RUBBER UNEO ❑ 3. EPDXY LINING GLASS LINING 095. UNKNOWN.433 DATEINSTALLED <br /> OR COATING <br /> (CAackanedeman ) ❑ 2. LKYD LINING ❑ 4. PHENOLIC LINING 8 UNLINED ❑99. OTHER <br /> Farbca/uas pnP) <br /> OTHER ONIFAPPUCA3 E 3.CORROSION <br /> TION <br /> PROTECIF AP1. MANUFACTUREOCATHODIC ❑ FIBERGLASS REINFORCED PLASTIC 95 UNKNOWN 434 DATEINSTALLED <br /> PROTECTION <br /> p4. IMPRESSED CURRENT ❑99. OTHER <br /> (Chaq.ifem W,) <br /> Cl❑ Z. SACRIFICIAL ANODE (Fprbeal use pnry) <br /> SPILL AND OVERFILL IGRp YEAR INSTALLED TYPE(Foriscal use ony) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Cneck a9fMf appy) 1. SPILL CONTAINMENT ALARM ❑ ]. FILL TUSE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE BALLFLOAT ❑ 4. IDEMPT <br /> ❑ 3. STRIKERPLATE <br /> TV.TANKLEAKDETECIION <br /> IF SINGLE WALL TANK DOUBLE WALL TANK OR TANKWITH BUDDER(CAapkonefumo <br /> ❑ 1, VISUAL(EXPOSEOPORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) ❑ VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATICTA.NK GAUGING(ATG) ❑ 8. VADOSE ZONE 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ ]. CONTINU01/SATG ❑ 7. GROUNDWATER ❑ 3. MANUALMONRORING <br /> ❑ 4. STATISTICALIWENTORYRECONCILIATION(SIR). ❑ S. TANKTESTING <br /> BIENNULTANKTESTING ❑99 OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PUCE <br /> ESTIMATED DATE LAST USED(YRIMO/OAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERUL7 <br /> ga9om <br /> E]Yea ❑NP <br /> _C.UPAFQRM t"91 Fofinerly SWRCS Form <br />