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... Y9e <br /> UNIFIED PROGRAM CONSOLIDATED FORM TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE I /3�1�3Pa9-aar,a ., II <br /> I---- -- P., <br /> . CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE <br /> TYPEOFACTION C]1.NEN SITE PERMIT [14.AMENDED PERMIT ❑ T. PERMANENTLY CLOSED ON SITE <br /> (GM k an.drm o0y1 <br /> ❑3NEWAL PERMIT (Sprue. -rerlpol ua4 WD (Sp.Cd/ s-krl.cal var onlYl ❑ 6.TANK 0.EMOVED 4b <br /> R= <br /> _ 1 <br /> FA f <br /> BUSINESS NAME)Sam.as fACIUTY NAME..DSA- <br /> v ear Aa) "f, <br /> LOCATION WTHIN SITE(CFO=nal t 431 V l <br /> - - L TANK DESCRIPTION <br /> ( NN MANUFACTVRE COMPARTMENTALIZED TANK ❑ Y.a ❑ N. <br /> TA <br /> ANKIO 17 ------- <br /> COI-AAA` T_ „l,j-5 If Yri,mmPl°b onapaya lcr taN WmpaM1.anl <br /> NUMBER O�COMPARTMENT$ <br /> DATE INSTALLED(YEARIMO) TANK CAPACITY IN GALLONS <br /> 67z 26oU Ir <br /> ADDITIONAL DESCRIPTION IFVl al vsr onYl <br /> -- ANK CONTENTS I <br /> TANK USE 432 PETROLEUM TYPE ❑ 5.JET FUEL <br /> �h. MOTOR VEHICLE FUEL 1. EGULARUNLEADED ❑ 6.AVIATION FUEL <br /> (1/nurkr0 compNU Pafm4vm Typ) PREMIUM UNLEADED [3 99 OTHER <br /> ❑ 2. NON-FUELPETROLEUM C. RADE UNLEADED 4. GASOHOL <br /> CAS FPmm HaaaNam Mahna6lnwnrorypagel <br /> 02. CHEMIGLPROOUCT CO ON" (Imm Mao,dout MaNMls lnv.nfprypa9Q <br /> HAURDOUSWAST_V-Wra <br /> r U+MWI <br /> 111.TANK CONSTRUCTION <br /> ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL VATM INTERNAL BLADDER SYSTEM <br /> TYPE OF TANK ❑ 1, SINGLEWALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> (Cord ens Arm.Ny) K2. DOUBLE WALL '❑ 4 SINGLE WALL IN A VAULT ❑99.OTHER <br /> ❑95. UNKNOVM <br /> TANK MATERIAL-pAmarl ura ❑ 1 BARE STEEL 3. FIBERGLASSIPLASTIC ❑ 5. CONCRETE <br /> k I only) ❑ 2. STAINLESS STEEL ❑ 4 STEELCIADWIFIBERGLASS ❑ 6. FRP COMPATIBLE WIIM%METHANOL ❑99. OTHER <br /> (CArE emiem REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-Ir Mary Mnk ❑ 1. BARE STEEL 3 FIBERGLASSIPIASTIC ❑ 6. FRP COMPATIBLEWIIW%METHANOL ❑95.C3 99 N <br /> (Chspk...A.m Pnlyl ❑ 2. STAINLESS STEEL ❑ 4 STEEL DIAD WIFISERGIASS ❑ S. FRP NON-CORRODIBLE JACKET .OOTHERTHER <br /> REINFORCED PLASTIC(FRP) ❑10. COATED STEEL <br /> ❑ 5. CONCRETE OATEINSTALLED <br /> ICI 5 GLASS LINING [395. UNKNOVNa33 <br /> TANK INTERIOR LINING 01. RUBBER LINED ❑ ]. EPDXY LINING 6. UNLINED ❑99. OTHER <br /> OR COATING - ❑ 4. PHENOLICWaING (For E INST LLED <br /> ❑ 2.ALKYD LINING DATE INSTALLED <br /> (CM.k pnr 6.m I <br /> OTHER CORROSION ❑ 1 MANUGALTURED GTHOOIC ❑ 3. fIBERGU55 REINFORCED PLASTIC 95. UNKNOWN <br /> PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPR=55ED CURRENT 099. OTHER (F.rbcal uaa.cly) <br /> (Clu.k o/I.Arm.nly) ❑ 2 SACRIFlCIAL ANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> YEA0.1 k£4 TYPE(Farbcal ua.only) <br /> WILL AND OVERFILL -- - -- <br /> ILL TUlilp SMUT OFF VALVE <br /> tMal apply) SPILLCONTAW 0 ❑ .ALARM <br /> ial a6 <br /> ❑ 2.BALL FLOAT ❑ 4. EXEMPT <br /> 2. DROP TU <br /> ❑ 3. STRIKER PLATE <br /> _ N.TANK LEAK DETECTION <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER(CAr k ane il.m only)- <br /> WSINGLEWALLTANK 49Maba➢ 1: ❑ 1 VISUAL(SINGLE WALLIN VAULT ONLY) <br /> ❑ 1. VISUAL(EXPOSEED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) <br /> ❑ 6. VAOOSE ZONE JCa l-yI 2. CONi1N00051NTER5TITIAL MONITORING <br /> 2, AUTOMATICTANKWUGING(ATG) ❑ ] GROUNDWATER ❑ 3, MANUALMONITORING <br /> ❑3. CONTINUOUSATG <br /> ❑ 4. STATISTIGUNVENTORY RECONCILIATION(SIR) Q9, OTKTIESTING <br /> BIENNIAL TANN TESTING <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE UST USED(YRIMOIDAY) ESTIMATED QUANTITY OG SUBSTANCE REMAINING <br /> 435 TANK FILLED WITH INERT MATERIAL? <br /> ❑Yo ❑N. <br /> ForrnerlY SWRCR Form <br /> CUPAFORM(4199) <br />