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UNIFIED PROGPk,�I CONSOLIDATEDINI O\ l <br /> UNDERGROU>ti-D STORAGE TAINK (2 <br /> OPERATING PERMIT APPLICATION-TA:N'K INFOR:NIATION(one tone per UST) <br /> TIPE OF ACTION (Check one item only. For an UST permanent closure or removal,compute only thissection and Sections 4 II,PII,IV,and AIX below) 430 <br /> ❑ I.NEW PERNfIT El 3.RENEWAL PERMIT �CHANGE OF[NFORIMAi'ION <br /> Q 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE U 8,UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: ""' DATE E.'{ESTD;G UST DISCOVERED: 430b <br /> I. FACILITY LNFORL�LMON <br /> F,�:ILITY[D$(Agency Use Only) <br /> BLS MNIE5S NAVF.(Same ac F-a(�IL[TY NAME or DBA-Doin¢Business AS) 3 <br /> BWNESSSITE ADDRESS 103 COY a 104 <br /> II.TANK DESCRIPTION <br /> TA:YK M 432 TANK bfANUFACTURER 413 TAr4g GONFIGURATTON:THISTA,,4K IS 434 <br /> J9 LASIMVD-AL,ONETAPIC <br /> ❑2.OYE INA COMPARTMFNM UNIT'. <br /> �� �� ConnleteoaC _£nraGt mrroasmert:m t5e mit <br /> DATE UST YSTEM STALLED 435 TANK CAPACITY ING LONS 476 NUMBER OFCOMPART\,CNTS W TfiE U,YIT 437 <br /> III.TAN USE AND CONTENTS <br /> TANK USE ❑ la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439 <br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARCO US WASTE(Includa used Oil ❑S.ESfERGE\ICYGENERATORFLIELWC9Zp81.5(e)I <br /> ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN z 99.OTHER(Specify): 439a <br /> CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Le.dIIDGRADE UMZ%-DED ❑ 1 b.PRE-1[UM UNLEADED <br /> 440 <br /> 3.DIESEL ❑ S.JET FUEL [I6.AVIATION GAS 04h'r- <br /> 8.PETROLEUM BLEND FUEL ❑ 9.OTHER.PETROLEU4 (S0,cj&t Li µ�� 440a <br /> NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL <br /> I I.OTHER NON-PETROLEUM S eci ): WkZEA_ *pj"e4 4 04406 <br /> IV. TAIINKCOMTRUCTIOIN <br /> TYP!OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNIN2 OW14 <br /> PRIMARY CONTAINMENT 1.STEEL a. 3.FIBERGLASS ❑6.INTERNAL BLADDER 443 <br /> 7.STEEL+1NTERN.AL LINING 444 <br /> ❑95.UNKNOWN ❑ 99.OTHER ( iFj): 444a <br /> SECONDARY CONTAINMENT ❑ 1.STEEL (]3.FIBERGLASS ❑6'EXTERIOR L1EbtBAA-JE LINER ❑7.LACI 445 <br /> ❑ 90.NONE [J 95.UNKNOWN JR99.07M(S "1: 1 :2 445a <br /> O VFIFILL PREVENTION X I.AUDIBLE$VISUAL ALARMS El 2.HALL FLOAT J.FILL TUBE SI[UT OFF V VE 452- <br /> ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPfM CONSTRUCTION 1.SINGLE-WALLED X2.DOUBLE-W.ALLED ❑909.OTHER 460 <br /> SYS IESI TYPE 1.PRESSURE 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION (14.SAFE SUCTION(23 CCR§'_636(x)(3)1 45a <br /> PRDA\RY CONTAINMENT ❑ 1.STEEL UK 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464 <br /> ❑90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Speeif . 464 <br /> SECCriDARY CONTAfNh1ENT ❑ L STEEL X 4.FIBERGLASS ❑ &FLEXIBLE ❑ 10.RLGLD PLASTIC 464b <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 464e <br /> PIP[NG/TURBINE CONCAI rMEIVT SUMP TYPE 1.SINGLE WALL ❑2.DOUBLE WALL, ❑ 90.NONE 464d <br /> VI.-,VENT,VAPOR RECOVERY(VR)A.NL D(RISERI FILL PIPE PIPING CONSTRUCTION <br /> VENTPRLMARY CONTAINMENT 1.STEEL 4.FIBERGLASS 10-RIGID PL :I C! 90. IONE'0 99.OTFIER(Specify) 464@ <br /> VENTSECONDARY CONTAINMENT I.STEEL 4.FIBERGLASS 010.RIGID PLASTIC 90.NONE Ll 99.OTHER(Specify) 464f <br /> VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 464fl <br /> VR SECONDARY CONTAINMENT El 1.STEEL 0 4.FIBERGLASS 10.RLGLD PLASTIC 9o.NONE ❑ 99.OTI(ER(Specify) �y <br /> VENT PIPING TRANSITION SUMP TYPE 1.SINGLE WALL Q Z DOUBLE WALL 90,NONE 464h1 <br /> RISER PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS ❑ I0.RIGID PLASTIC 90.NONE C1 99.OTHER(Specify) 4641 <br /> RISER SECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS E3 10.Itl13ID1:11AS11!711 �90.NONE 99.0713ER(Specify) �t <br /> FILL COMPONENTS INSTALLED ❑ L SPILL BUCKET 2 3.STRIKER.PLATE/BOTTONI PROTECTOR 4, 464ki <br /> CONTAINMENT S Uti(P 451 a c <br /> VII.UNDER DISPENSER C01NT.ALrMENi"T(L-DCj <br /> CONSTRUCTION TYPE ❑ I.SINGLE WALL ❑2 DOLBL-E W% L 3.NO DISPE`�SERS 90.NONE 469% <br /> CONSTRUCTION MATERIAL ❑ L STEEL ❑ 4.FIBERGLASS Cl L0.RIGIDPL1i'TIC M99.-ETHER(Speaifyl 469bo <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL,ANODE(S) ❑4.IMPRMED CURRENT ❑ 6.ISOLATION 448, <br /> LX. APPLICANTSIGNATURE <br /> CERTIFICATION: f certify that t '-T system is compatible with the hazardous substance stored aad that the inforstntioa provided herein ik.(rue,accurate, <br /> and in ful m li nce with legal re 't�Mears. <br /> APPLICANT SIGNAT-URr2,, DATE ? <br /> d O 470. <br /> APPLICA.'1T NAME(print r 471 <br /> APPLICANT <br /> ME 471_ <br /> UPCF UST-13-1/2 <br /> Rev.(l.+Q7) <br /> ,..L <br />