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MAY-11 -2010 11 :22 AM P. 04 <br /> UT ED PROGRAM CONSOLIDATED FORM TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two puma per tank <br /> TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 3 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> _ _ Q 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT lBDery reeedn-Ipr mer la4 prY) (Sp4cify n4eov-firldulua ay) ❑ 8 TANKREMOVSD <br /> FACILITY ID <br /> BUSINESS NAME(/rmeet FACILITYNAME q,gaA-ml,y Bueln.n Ae) 3 Q Q 3 O- <br /> O ( 431 <br /> LOCATION WITHIN 511(opdme0 <br /> L TANK 51u;0FPT'LON (A scaled plot plan wt <br /> ih the location at'the UST 1y lea including hnildings and Imn marks shall a sabenitt w the Imeal agency.) <br /> TANK ID M to TANK M NDFACTLIRER q3 COMPARTMENTALIZED TANK Yea No aa4 <br /> d 0� /LL) G$ n•vs,vvmD«.m.Ftp mdxm ndpemwni, <br /> DATE INSTALLED(YEAKIMO) ne TANK CAPACITY IN GALLONS 43- <br /> WMBER OF COMPARTMF,N'TS 439 <br /> mis <br /> ADDITIONAL DESCRIPTitlN(rm Idem v e"I <br /> 11.TANK CONTENTS <br /> STANK USE 639 PETROLEU TYPE 'mo <br /> (9/ <br /> FOR VEHICLB FUEL [3 le. EOULAR UNLEADED 133. LEADED ❑7. JET FUEL <br /> (I1mvWdcomDlee Petroleum type) PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL <br /> ❑2. NON•FUF.L PETROLEUM C3 IvMIDORADE UNLEADED C3 4. GASOHOL 99.OTHER <br /> [3 3. CHEMICAL PRODUCT' <br /> COMMON NAME (bora He+ardvm M-11-11ilmmmry pear) 441 CASm(mdm HntMDlu Mrmelemwnemy pepel <br /> (3 4. HAZARDOUS WASTE <br /> ()order Ceed OIB RL <br /> ❑95.UNKNOWN <br /> 111. TANK CONSTRUC'T'ION <br /> TYPE OP TANK I. EINOLP.WALL 3. SINOIb WALL WITI 5. SINGLE WALL WITH INTER .4L BLAP ER SYSTEM W <br /> (Cbc"pee Idea try) EXTERIOR MEMBRANE WNPR 09. UNKNOWN <br /> DOUBLE WALL ❑4. SIONLE WALL M VAULT ❑99. OTHER <br /> A A -pdmveyredtI. BARE,..TEFL FIBB ASS/PLASTIC s. ONCRETP. 5. NKNOWN 444 <br /> (Chrk one(dam defy) 02. STAINLESS STEEL Q4. STEEL CLAD W/PIBEROLASS ❑8. FRP COMPTIBLE WA00%METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-eeeatrry lW 1. BARFSTEEL W. FI EROLA9S/PLA. IC 5. CONCRETE. 97 UNKNOWN <br /> (Ch4mk mei�em mM ❑2. STAINLESS STEEL. 04. STEEL CLAD W/FIBERDLASS E3 8, PRP COMPTIBLE W/Imm44METHANOL [3 994 OTHER <br /> REINPORCED PLASTIC(FRP) ❑10.COATED STEEL <br /> [3 3, CONCRETE <br /> TANK INTERIOR LINING J.R1188ER LINED 3.EPDXY LINING in L'3.GLA33 LINING 95.UNKNOWN wn DATEINSTALLED us <br /> OR COATING [32 ALKYD LINING ❑4 PHENOLIC LINING II-e UNLINED ❑99 OTHER (Fie 1w eY d,) <br /> (Cheek vee idem 0*) <br /> 4 DATE MSTALLRP 449 <br /> OTHER CORROSION r-1 1 MANUFACTURED CATHODIC ❑3 FIBEROLASS REINFORCED PLASTIC ❑95 UNKNOWN <br /> PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER <br /> (CMek ere heed dry) ❑2 SACRIFICIAL ANODE (Pet[died we ml <br /> SPILL AND 0 RL YEAR INSTAI.I.ED 439 TYPE Ilocel vw odd) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 4322 <br /> (Cheek di do apply) ❑I SPILL CONTAINMENT ❑ 1 ALARM 3 FILL TUBE SHUT OFF VALVE <br /> of DROP TUBE ❑2 BALL FLOAT 4 EXEMPT <br /> []3 STRIKER PLATE <br /> IV.TANK LEAK DETECTION(A deeeipdm dame momrmea pmpev them b.eobmited a die w ai yrey.l <br /> IF SINGLE WALL TANK(Ca.k ed ihid ,1,) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 4% <br /> Ceakemlamdry) <br /> 01 VISUAL(EXPOSED PORTION ONLY) ❑ (M <br /> 5MANUALTANKOALOINOTO) 6I VISUAL(SINOLP.WALLIN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK OAUOINO(ATG) ❑6 VADOSE ZONE ks CONTINUOUS INTERSTITIAL MONITORINO <br /> ❑3 CONTINUOUS ATG ❑7 OROUNDWATER ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTHER <br /> IV,TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATF.LAST USED(YR/MMDAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAININ0 44a TANK FILLED WITH INERT MATERIAL? 431 <br /> gallons o Yea a No <br /> UPCF(12199 revised) 10 Formerly S"CB Form B <br />