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P. 11
<br /> MAY-31-2010 11 :25 AM
<br /> FIED PROGRAM CONSOI,IDA1'F.D FORD
<br /> "on" UNDERGROUND STORAGE 1-ANK
<br /> OPERA'CINGPERMIT APPLICATION-TANK INFOIZMATION oncfnrn U51 �b
<br /> bon"TYPE OP ACTION (Check one item 01,1]'. for an LIST Ixrmancnl cbeure or remaVRl,cnmpletc only This�'S CHANGE OF INFORMATION hplow)
<br /> am Scoucans 1.
<br /> 1,NEW PERMIT' cl ?.RENEWAL.PERMIT
<br /> 6.TEMPORARY UST CLOSURE 7.UST PERMANENT M URE.ON SITE S.I1S"I'REMOVAL Alm
<br /> DATE LS'I'PERMANENTLY CLOSED'. BATF F:XISTINC UST DISCOVERED:
<br /> 1. FACILITY INFORMATION
<br /> FACILITY IU N(Agcmy Tine Only) -
<br /> 1
<br /> RIISINESS N f:(S a as F Cf LIT'Y NAME,,,DDA•Il jinn Boniness A,)
<br /> Irw �v
<br /> As EngL� c e A W D_oc� . .._ _...,_....._- a
<br /> !_`�.L --, '_NL. _ �VET.__.1 ..CITY
<br /> JATE;US
<br /> .AUyICESp' C'�e '� �'�W►^ 11.TANiK DESCRIPTION_ __ _:AK1An� . 1 'Af1K[PN�+I[lliRAT(M: 'THIS 1'ANKIS! 7M n� ' �`y�IAArANbALONC TANK
<br /> D / L_I'L.01SLINACOMPARrMENTLDUNR( 1� �-�,_ nmmtintbalil. (]7
<br /> SYST"est INSTALLL"•D ] TAN (1APACi'fY IN(.{ALLONS e4e NUMHFROPC'UMPAKOVIEN"1'S IN THC IJ1I"1'
<br /> III.TANx,USE AND CONTEPrrS
<br /> - U9
<br /> TANKUSC $,la MOTOR VEHICLE FIJRI.INO ❑ Ib.MARINA MIM INO [3le.AVIA'rION F'UEL1N0
<br /> �'j 3CIFE.MWAL PRODUCT ST(Ill Cl a,11AZARDOUSWAS I1:Nrd-illUn 05,EMERGENCY GENERATOR Pl1RLlHsc Imei.Rell 41%
<br /> ❑ 6.UTHERGENL'R.\T'ORrULL ❑ 95.UNKNOWN ❑ 7],OTFIER S kl )I M9
<br /> CONTHN"IS PETROI.EU ❑ Ia.REGULAl[IINLEAM'.O ❑ In MID(Irt.NOH l!NLGADED Ib.PREMIUM UNLEADED
<br /> V t.DlLhEL L] ).ilii F(lct. 6.P.19ATION GM
<br /> O'OIER_iROL::LbI SJmn
<br /> [3s.PETROLEUM IIT"I+A!U I°.111 ❑ 9. S aai.
<br /> NON-pETR011 7.L'SP.DOIL. T`I 'U.lia'nAN+N. u0b
<br /> ry 1I_O'191CR noy.PF.I'RO:rI!hi.C.(w'°J.h2'_J....------'•'-
<br /> -'- lV. 'R'AN'K CONSTRUCrr10N
<br /> 1 95.UNKNOWN J•--- 141
<br /> rPRlMARYC'ONIAINNHlNI
<br /> TANK^ d i.SMGLP.WALL 2.DOl nbti WALL [] 444
<br /> ' [] 1.,'I'E'EE 3.FIHF'.R(:Ln59 6.INIMINALBLADDI'R
<br /> LSTIILLtINfER ALUN!NG ❑ 95.1:NKNOWN ❑ 99.OT1-TERSRY CONI"AINmENT ❑ 1..srULL 1.FIHERGLASA ❑ 6.-c'iTf,RIOR MRMDRANf:LINPR ❑ 7.JACKFIhU u]L] '0.NONE 95.IINKNOWN 0199.0'!'4{�17lSmdN
<br /> L.PREVENTION ❑ LAUOf))L fi.vISI1nI,ALr\RMS IJ?.tiAIi.FI,i i,1T 9.pn.l.'1'IJSE 9HUTAr•F VALVE
<br /> ISE.
<br /> ❑ 1.TANK MEETS RRQIIIREMENTS VOR EXEMP'T'ION FROM OVIAH L PREVENTION EQUIPMENT
<br /> V. PRODUCT"I WASTE PIPING CONSTRUCTION
<br /> _ ow
<br /> PIPING CONSTRUCTION ,INC ;i.nnl!ULF�WALI.FO.•_$u.OTHER _ 451
<br /> SYSTP.M TV W: P_RCSSI m.-. ❑ p'.\'1'"Y ^ 1.('T4,5�',IONALSU['TION ❑ 4.SAPE8tJCT10N M(11 'x636.1])1
<br /> Ifc6-" 111r.RCl.A.'S 7 Y.PI-UNULL ❑ 10.RIGID PLASTIC 464
<br /> PRIMARY CONTAINMENT 464a
<br /> 0 _❑ 90 NONE 95'UNK MOWN 99 OT116R(Sp Ht
<br /> SECONDARYCON'fAINMFN7 -Is I'F..fi1 J f•I!i[Rcd.Asb [] A.H.I:AIIA.F, ❑ RI
<br /> GIDPLASTIC 4646
<br /> �r. ;KKnOUN ❑ 99.UTI IFK(S ca •)
<br /> 1'IPINGMJRDINi.('ON'fAINMEN'r SUMP'I'Y PE -_ iING1.iJ.WALt. �] eyhOUAL1i.VAL.L ❑ 90.NONR �
<br /> VI.VENT',VAPOR RECOVERV(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION
<br /> VENT PRIMARY L'ONrAINMRNT -•�❑ I.F'/1'S.EL A EinER A55 I RRiID PLASTIC -�9.NONE 99.OTHER(Specify) de(e
<br /> 6del
<br /> 41,4
<br /> VENT But'oNMRN'CON IAINMI,.N'I'Jr [] LS�'F.EL �I.PI9ERGLActi In.RiUlfr l+LAS DC 9t,NONE' 7).O'fIIER(Spcclly) tM4
<br /> vR I%IMARV mN'1'nINMENT LgTR- ,,F19h.R[R_s uS'lL�, I'i dIi�ID I'1.A5'i 1C' 40,NONE 99AYRIER(Spaet l 4461,
<br /> e 1,i
<br /> vIt SECONOAAY CONTAINMENT .._� F-sl Ia. ,,flm{ROLASS 10.RIGID PL N.57C ' 90.NONr•. 99.OTHRR(SPeelgl 46TM
<br /> 4641,1
<br /> VENT PIPING'I'NANSITI(,)N R(,IMI+'rN:Pl.i ( L ti1M1(i1.Ii_WAI:. 2.7Ol_D1,[W\LL 90.NONE Mi1
<br /> .�_'._
<br /> RISER PRIM.\RY I:ONTAiNhIRNTL51'I:h'1, ❑ J.FINEROL•\SS 1Tin"Ririn PL. 'It(' Ju 90.VONLe '19.OTI)ER(Spxly)
<br /> RISER SECONDARY CON'1'=1iltEN1' L S'f'.RI. 1.F!RR1+i,A-s5 .. �n.Til"I;)19_ASTIC ')O.NONE: M.OTNFR(%-m-,fy1 1641,
<br /> 4WI
<br /> FILL CONIPONEN'IN INSTALLED LRP!LI_BUCKET Tom . 1RIKita iTLw %BC.fJFA PAO'I'['CTOR s.coN1'AINMENTSUMP 44 m�
<br /> � _--_tom.._--__.--.....=-.
<br /> V_II.UNDL'RDISPr:NSERCONTAI!1IMENT(UI )
<br /> CONSTRUCTION TYPE LSL`IUI,E W'.ALi. 471. ❑ 1.NO DISPENSERS ❑ 90.NONE
<br /> f�I i.Fl f.r.l::iLf.$° J tIJI'1.151'1: •' ") f1T4EA S u ) Its.
<br /> CONSTRUC"ITON MA'rtt:O SL I^ '.'1 ''.r'.I. _Q-��- _
<br /> YIII. CORROSION PRO1'ECTION
<br /> STRF.I.COMPONI?h"1'I`kU•15L`710N ❑ 1.SACRIFICIAL ANODII(S:•
<br /> •1 !AIPKEssEn ultl ❑ 6.ISOLATION ue.
<br /> I%(. APPL.ICAN T SI1.7:,ATUR.E
<br /> CERTIFICATION: I eedif) that this I!ST Intern ll enmpntibla with the h l"i'dous substance l4orad and that the In(orml"ll haPele Is trot,neeoente,
<br /> and In full tom])lance withIe�(nl rcydrerlend__„__ 046
<br /> APPLICAN-7MjNITl1RF, Q DA'!1'!
<br /> A
<br /> _ �irL,�^1x_4`'•.'
<br /> 1,.
<br /> APPIACANI•NAMC(print) ra. r gPM,I(a>:'T 744444,E
<br /> UPCF UST•B_1-177,
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