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Mf+Y-31-2010 11 :24 FIM P. 09 fi' <br /> 1 TIED PROGRAM CONSOLIDATED FORTY - <br /> UNDERGROUND STORAGE TANK <br /> OPE TING PERMIT APPLICATION-TANK INFORb1ATION One V, n er and IX bel 430 <br /> TYPE OF ACTION (Check one item only. Foran T permanent closure ar removal,complete only this se❑9ti i' VA <br /> eVAN 3E OSF INP111,IORMA ONd IX�(�) <br /> • [] I.NEW FERMIS' 3.RENEW AI.PF.RMI"I' 8.UST REMOVAL <br /> 7.UST PF.RMAN F.NT CLOSURE ON SITE 006 <br /> &TEMPORARY UST CLOSURE a)oe DATE EX15TING UST DISCOVERED: <br /> DATF.UST PERMANENTLY CLOSED: <br /> I. FACILI'f1f INFORMATION , <br /> gPCI ITV ID k(Agency Use Onty) ) <br /> 9 (iSS N E f Samc es FAJ Q L•or DRA angBusw(�wrs c{On- -1 E. *J-1 �✓17 A 104 <br /> O• ••t1 lav o'.wl TV <br /> DUSINF�S SF.A <br /> ELDDRHS: <br /> ry 11.TANK DESCRIPTION 4( <br /> alb Alt 91"A <br /> A� •CONPIOURATION'. THIS TANKIB <br /> TANK IDN T TANK MANUFAL'IT,)RER (31 ASTAND-ALONL TANK ' <br /> COMPARTMENTE DDNIT. <br /> i0ftif7oaR� QCw L(n /�G'r-/vJ eo Ideaw ror mch coin.nmm lrl <br /> <) 'TANK CAPACITY IN GALLONS 4)4 NUMHER OF COMPARTMENTS NTS IN FN THE UNIT <br /> DA INSTAI.I.F:D ( Od <br /> TIL TANK USE AND CONTENTS d19 <br /> 'TANK L)RH ' s.MOTOR VLI)ICLE FlIeuNG d 19.MAR)NA FUELING ❑ Ic.AVIATION FUENER <br /> R4399a <br /> 3.CHEMICAL PR[wUCTS'IYIRAGF. ❑ d.HAZARI%)US WASTE Godwin une4 olq � EOMEG (YYOE'ERATOR FUEL IW[)a5261 i(cll <br /> ❑ b.OTHF.R GENERATOR YUEL ❑ 95.UNKNOWN 44e <br /> CUNTL•N'I'S PETROLEUM; L.Rn(illLAR UNLEADAD Sc,NTIDOfADE UNLEADED � 6bpV1 SON GA5 UM EppFb 4401 <br /> 1.D(F51[L ❑ <br /> ❑ s.PLTROLnuM BLXND FUEL 010 CTHpNPETROLEUM S i L' <br /> NON-PETROf.n11M. 7.USED OI7, L410E <br /> ❑ 11.On IFR NQN•PEFROL.FUM s i : - <br /> IV. TANK CONSTRUCTION <br /> 'IYPEOFTANK t.5I GLLWAL), 2.noUBLE WALL ❑ 95.UNKNOWN <br /> PRIMARY(I%'I AINMRNT I.STFri. WI.FInERGLA5% ❑ a.IN'1'ERNAI.RLADDER 411. <br /> ].STElil.r INTERNAL I.ININU ❑ 45.UNKNOWN ❑ 99.OTKER S Y <br /> SECONDARY t'ONTAINNIENT ❑ I.S'I tr.' ..FIBERGLASS ❑ 6.FXTD:RIORMPMRRANELINER 7JACKETED 4Ge <br /> 90.NONE9 <br /> OVERFILL I3.UNKNOWN 099.OTHER 5 i ): 4n <br /> 'REYEN)'IC)N L AUDIBLE R.VISUAL ALARMS 2.BALI.FIA)A'1' 3,FILL TUBE 511t1T-OFF VALVE <br /> ❑ 4.TANK MEETS REQIIIREMEN'IS FOR FXLMPTION FROM OVERFILL PREVF.NTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION aw <br /> PIPING COVS'1'ItUCTION LSINGLI•:WALLED 2,DOUBLR•WALLED 99.OTHER 459 <br /> SYSTEM-'7- ' 'I,P4RRYIIRE ❑ 2ORAVITY ❑ 5.Cl7NVENTIONAL SUCTION ❑ 4.5AF'E SUCYION 1C('R ]qe()) <br /> PRIMARY(.Y)N'1'AINMLN'1' ❑ I.ETF,FI, 4.FintiRGLASS ❑ R.FLEXIBLE ❑ 10.RIGID PLASTIC 46x4 <br /> [] 9o.NONE Ej 95.UNKNOWN ❑ 99.OTHERS ri ): l b <br /> r I SIX ONDARY CONTAINMENT I.STEFi. 4.FIBRRGLASS ❑ 5.F01 1X1%LC ❑ 10,RIGID PLAS'GC <Mo <br /> ❑ nn.NONE Q S.UNKNOWN ❑ 99.OTHF.R(S i ): 4e4e <br /> . PIPINCxTURItINE CON'I'AINMEN'CSUMP'I'YPL LSINOLEWN.I. [32.DOIIDLEWAI.1, Ll90.NONE <br /> VI.VENT,VAPOR RECOVERY R)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT pRIMAR`!COKI',\INMET7T I.5'rFF.I, 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.0'CHER(SlreNfy) aMel <br /> --In <br /> �e 10.RIGID PLASTIC 90.NONE 99.OTHeR(Speeity) <br /> VENT SFAONOARY CONTAINMP:N'I' LI 1.5TI:EI, 4.PIBGROLAS$ 464r1 <br /> (4+9 <br /> VR PRIMr1RV['GNTA'NM15NT 1.S'CEE1. 4.FlRERGLASR 10.RIOIU PLART[C 90.NONE 99 OTHER(5peoifY) 1 <br /> - 464k <br /> VI(SF-CONDARY CONTAINMENT L 5)'RRI. 4.FIBERGLASS 10.RIGID PLAS'GC 90.NONE 99.OTHER(SPeeity) 49.4h1 <br /> 2.LwUnLE WALT. 99,NONE "i' <br /> VENTPIPINC'T.RANS(TIONSUMP'rYPE cINOLE WAI.I- 4941 <br /> LASER PRIMARY CON'i AINMF.NT I.STP:LI. I.FIBPRULASS I0.RIGID PLASTIC 90.NONE 99.OPTER(SPxlfs) 1 <br /> 4661, 1 <br /> RISP.R S14 ONDAICY CONTNNMENT 1.S'T'EEL 4.FIRERGLA5S 10.RIGID PLASTIC 90.NONE 94,OTHER(SPedry) 4Nkl <br /> ' FILL L'ONIPONItN'151NS'I'ALLED .SPILL BUCKET 3.STRIKER PLATE/BOTTOM PNOTECTDR 4.CONTAINMENT SUMP651eti <br /> Vii.UNDER DISPENSER CONTAINMENT llb laa <br /> C(IVS'fRll('^TUN T`.'PE I SINULH WAC.L ❑ 2.UOUPLe WALL ❑ 3N0 DISPENSERS ❑ 90.NONE pm e <br /> CDNSI'RD(CTWN MATE'CIAL ` FEET. a.PIDERGLASS 10.RIGID PI.ASrIC 99.OTFILR9 <br /> VIII. CORROSION PROTECTION ... <br /> 5'niLL CONIPONFN I'PRO ECT <br /> ❑ 2.5ACRIMiAL ANDD&S) ❑ 4.IMPRESSED CURRENT ❑ t11OLATp1!u147 <br /> IX. APPLICANT SIGNATURECERTIEIC.A1'It)N. 1 ePnlry that Ihle 1'ST 9y5tem H rompallble Rrilh the h■zard0RA 9ubsMeee Stored and th■t the InroR■e■unte. <br /> and in full com IianL Ce with I!,!it rg oirement9. 4'q <br /> DATF <br /> APPL.I(:AN'{'CR'.V Al <br /> ■„��``J/,� 99 <br /> fA`S1f0(slrl- aYr. lri. <br /> ! APPLICAN'I'NAMI?(,xi)q <br /> APPLICANT TITLE �r <br /> orcR us•F-r:1"p. <br />