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iUNIFIED PROGRAM CONSOLIDATED FORM TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 /3/Q� <br /> / (nav paSes per rani, I <br /> P+9e al <br /> S.CHANGE OF INFORMATION) ❑ 5. TEMPORARY SITE CLOSURE <br /> TVPEOFACTION 01.NEN SITE PERMIT ❑ +.AMENDED PERMIT 07. PERMANENTLY CLOSED ON SITE <br /> (Lmci om IMm oNy9 <br /> ❑].RENEWAL PERMIT (SpeF✓Y n+aon-brloCal uae amy) (Sp✓1y Nenge-brlactl un Pnly) ❑ 5. TANK REA10VE0 ab <br /> I <br /> BUSINESS NAME lSame as fACILItt NAME pr DBA-Dan98u>meaa <br /> FACILITY ID <br /> P&/Z-5m;1� <br /> LOCATIONYATHINSTc(OFe:n+O p1 <br /> / TANK UI.T�ANK DESCRIPTION <br /> LOMPARTMENTALI2E0 TANK ❑ Yea <br /> N No <br /> I/y -//,l� II Yei tnmPiele ona Dage to eatll rnmoaeL.enl` /L'`A /]/ NU MBEROFCOMPARTMENTS <br /> DATE INSTALLED(YEAWMOI TANK CAPACITY 1N GALL N$ <br /> Z i la boa 4A L-u'N <br /> ADDITIONAL D SCRIPTION IFPYIxM uae only) <br /> II.TANK CONTENTS <br /> TANK USE 432 PET0.0LEUM TYPE ❑ 5 JET FUEL <br /> � t REGULAR UNLEADED 0 2. LEADED 1. MOT00.NEHKLE FUEL ❑ 3. DIESEL ❑9 AVIATION FUEL <br /> Pymad.a,campNh Pefn4um Typo - 1D. PREMIUM UNLEADED <br /> �0 2. NON-FUEL PETROLEUM tc MIDGRADE UNLEADED 0 4.GASOHOL ❑99.OTHER <br /> 0 3.CHEMICALPRODUCTUSa(M1am XualCpaa Mafanala brenfaryp+9e) <br /> COMMON NAME SO.".. <br /> dova MaNMb lnvanroryp+ge) <br /> 10,./4 HAZAROOUSWASTE(InG O$ <br /> U,W O-0 <br /> 111.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLE WALL 03 SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BUDDER SYSTEM <br /> EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> (Cl Ck oro Mm PW gr 2. DOUBLE WALL 'OA SINGLE WALLIN A VAULT 099. OTHE <br /> TANKMATERIAL-P+mary 1, SARR <br /> uni /0 3. F19ERGIASSIPLASTIC ❑ S. CONCRETE 095. UNKNOWN <br /> (Gec4em Pem oNy) ❑ 2. STAINLESS <br /> STEEL ❑ +. STEEL CLAD WIFIBERGUSS ❑ e. FRP COMPATIBLE WI133T.METHANOL 0 99. <br /> OTHER-REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL HmK-q Mei 0 1. BARE STEEL N 3 FIBERGLASS I PLAW/ <br /> PLASTIC ❑ B. FRP COMPATIBLE 103%METHANOL ❑93. UNKNOWN <br /> em x+m anM 0 2. STAINLESS STEEL / ❑ A STEEL CUD WIFIBERGUSS ❑ 9_ FRP NON-CORROOISLE JACKET 099. OTHER <br /> REINFORCED PLASTIC(FRP) 010 COATED STEEL <br /> 0 5. CONCRETE OATEINSTALLEO <br /> TANK INTERIOR LINING 1 RUBBER LINED 0 3. EPDXY LINING 5. GLASS LINING 095. UNKNOWN.41] <br /> ORCOATING ❑ A PHENOLIC LINING 0 5. UNLINED ❑99. OTHER (Fa lxLuae pn)I <br /> ❑ $. ALKYD LINING DATE INSTALLEO <br /> Uecipm aem on ) <br /> OTHER CORROSION 1. MANUFACTURED CATHODIC ❑ ]. FIBERGLASS REINFORCED PLASTIC 95. UNKNOWN + <br /> PROTECTION IF APPLICABLE PROTECTION 4 IMPRESSED CURRENT 099.OTHER (Far KK+I uae Pnryl <br /> ,CuKk W ibno w ❑ 2. SACRIFICIAL ANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Fprlpcal uas aHyl <br /> A]n.kavNtaPPS') 0 1, SPILL CONTAINMENT 0 1,ALARM Cl 3. FILL TUBE SHUT OFF VALVE <br /> 0 2. DROPTUBE 0 2. BALL FLOAT 0 A EXEMPT <br /> ❑ 3. STRIKERPLGTE <br /> IV.TANK LEAK DETECTION <br /> IF DOUBLE WALL TANK OR TANKYRTH BUDDER(Check ane Rem PnM <br /> WSINGLEWALLTANK +ffm.t.p 1' <br /> ❑ 3. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑(1, VISUAL(EXPOSEO PORTION ONLY) 05 VADOSEZONE Z CONTINUOUS INTERSTITIAL MONITORING <br /> 1p 2. AUTOMATIC TANK GAUGING(ATG) ❑ 3. MANUALMONRORING <br /> 0 3. CWITINUOUSATG 0 T. GROUNDWATER <br /> Cl 4. STATISTIGL INVENTORY RECONCILIATION(SIR) 0 B. TANKTESTING <br /> BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> T,INERT MATERIAL) <br /> ESTIIUTEDDATEUSTUS_--O MOIDAY) ESTIMAI <br /> ATED OVANTITY OF SUBSTANCE REMAINING <br /> +]5 TANK FILLED VA <br /> ga9ana ❑Yn ❑Np <br /> FDrmetly SWRCS Farm E <br /> CURAFORM(4199) <br />