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to UNIFIED PROGRAM CONSOLIDATED FORM 600vife UNDERGROUND STORAGE TANK nm from per UST) OPERATING PERMIT APPLICATION-TANK INFORMATION ( E OF ACTION (CArk am Rem only. FRv a USI-closm or removal,-plere only v-searton"00 S e S CHANGE OFF 1N Ob,10.) N 1.NEW PERMIT ❑ 3.RF NI.wAL PERMIT S_UST REMOVAL G.TEMPORARY UST CLOSURE T UST PERMANENT'O ASI IRE ON sm ❑ 4 ,, DATE UST PERMANENTLY CLOSED: + DATE EXISTING UST DISCOVERED: I. FACILITY INFORMATION FACRdTT IDa(ARemY U-0*) BUSINESS NAME(Smne m FaailiryNmu orp$A-Dolnq Bulinn'a A4J •SGL-}t 03 CITY Toa. BUSINF-SS SITE ADDRESS } �pI IL TANK DESCRIPTION 4M fin- TANK MANUFACTURER '71• TANK CONF[GURA7'LON:TFttS TANK IS TANKmB S (] I.ASTAND-ALONETANK Comolnewspy<fmnA ri 3.ONEtNA COMPARTh-E-)UNIT anpnmv0in0awut UNIT 437 DATE UST SYSTEM INS FD 431. TANK CAPACITY ONS + Nl1MFSP.R OF COMPARTMENTS IN 7•NE III. TANK USE AND CONTENTS <39 TANK USE ❑ I>L MOTOR VEDCLE FUFI.ING 0 1h.MARINA FUELING ❑ lc.AVIATION FUELING 0 l CHEMICALPRODULTSIORAGE 0 4.HAZARDOUS WASTE(bdvaa n.eA 0il7 ,SOA S�.I URGENCY TORFURL INSC 41536LR41 _ _ ❑6_OnagLCENERATORFJM ❑93.UNIUIOWN 3 lb. $UNEE ED gip. CONTENTS PETROIEIIM: 0 "REGULARtJNLEADED 01c.h4DORADE UNLEADED 06.AVIATIONGAS OUNLFADED 0 3.DIESEL 0 S.JET FUEL 4� ❑ 8.pETEOLEUMBLENDF'UEL 0 9.OTTER PETROLEU11(SpeiCY7: ---'-- NON-PETROLEUM:C(-7-USED OIL ❑ l0. O ,�. l 11.07HER NON-PEH[OLBUM IV. TANK CONSTRUCTION r!VERFI ANIC__ .{-.SINGLE WALL ❑ 2DOURLE WALL (]95.UNKNOWN_ _____-_----____-.___ . CONTAINMENT rp�i-STEE ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 0 7.STEE+INTERNAL LINING ❑ 9S.UNKNOWN Q RY CONTAMENT ❑ 1.STEEL 03.FIBERGIAS9 ❑ 6.FMFJRIORMiBE1IF1�R 0 7.lACKEIED 0 9o.NDNE ❑ 9s.R7N1O+owN _ a±PREVENTION r I.AUDIBLE&VISUAL ALARMS E7ETP170N PROM OVERFILL PRE7/EFT70NS1PMENT4.TANK MEETS UIREh¢FTSV. PRODUCT/WASTE PIPING CONSTRUCTION 460 ONSTRUCTION__❑ 1.SINGLE WALL ❑2_DODeLE WALL O-9s.o7I�R -. -_.---. SYSTEMTYPE-_ _p_l_PRESSURE 02.ORAvm _ 0 ODNVENI70NA1.3--gN O4.SAF25UCTON,(y CC!R�Nas(e�(3>1_.-__.. :. pRInJA[iY coNf_RREN T O L STEEL 0 4.FIBERGLASS O S.F•LEMBLE O to.wRi7o rlAsnc 0 9D.NONE 0_9s UNKNOWN a 99.0THER(SPec'5 SECONDARY CONTAINMENT 0 ❑ 1.STEF1. 4.FIERGIASS ❑ 8.FLF708LI DID-R701D PLASTIC 0 90 NONE 0 95 UNKNOWN 0 99.07}ER(S�o"_Ty)_ 4b1d PIPINGJIUREINECONTATNMENISUMPTYPE 1.SINGLEWAIA. 02.DOUBLEWALL 090.NONE VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 7.Siffi. 0 4.FIBERGLASS 0 10.R(G1D PLASTIC-L% -NONE 0 99.OTHER 15P�5'L vat_ VENT SECONDARY CONTAINMENT_❑ I.STEE. 04.FIBERGIASS _❑ Io.IRIGLD PLASTIC UB-w ONE 099.017IER(Speeiy): awn. VR PRIMARY CONTAINMENT O L STEEL O 4.FMBXGLASS 0 10.RIGID PLASTIC NONE 99.OIT®t(Spec(fr): awe°. VR SECONDARY CONTATNA¢STC ❑ 1.STffi. ❑ 4.FIBERGLASS _.0 lo.RlomP1.ASTC 9o.NONE ❑99.aTRRER(swab'): 4+�+�'T: VENT PIPING TRANSITION SUMP TYPE ❑ I.SINfiI.E WALL 02IKR1BLEWALL .NONE __- _ -.... ._- RISERPRIMARYCONTAINMENi ❑ I.ST'FEL ❑AFIBFROLASS ❑ 10.EOID PLASTIC 90.NONE 0 99.OTHER(Specify): RISER SFAONDARY CONTAINMENT ❑ 7.57781. 04.FIBFRGLASS ❑ 10.RIGID PLASTIC .NONE 099.OTHER(Specify): 4+N�1. FILL COMP)N77NTS INS'[ALLID ❑ I.SPELL BUCKET ❑ 3.STRIKER P(A777BOITOM PROTECTOR 0 4.CONTAINMENT SUMP VII. UNDER DISPENSER CONTAINMENT(TNTC) CONSIRUCI7UN TYPE.__- .._-___0 1.SINGLE WALL __-._._� 2.DOl18LE WALL-___ 3.NO DISPENSERS 0 .10.NONE 469a CON>TRUCTON MATERIAL ❑ 7.STEF1 ❑4.FIBERGLASS ❑ 10.R1GID PLASTIC ❑ 99.OTI7ER(Spedfy) VIOL CORROSION PROTECTION STEED.COMPONENT PROTECTION 0 2.SACRIFICIAL ANODE 0 4.IMPRESSED CURRENO' 0 6.ISOLATION IX. APPLICANT SIGNATURE CERTFFICATIONI I oerdfy that this USC system is ,nmiutble with the asnrdoas sBbsteace stored and Nat Nc i"tot7lulTov prw'ided herd" IS trva RET" and in fvll m Race with t "iremems. m0 APPLICANT SIGNATU lr..- DA 1 1 J a'rs. 411' APPLICANT7TTL APPLICANT NAME(print) Ja ,e, al`�� uJ Il- UPCF UST-B Rev.(I1R007)-IR www.anitimmarg 9 -d 909192BG02 21eJ3 eEb160 01 40 ReW