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iUNIFIEDPROGRAM CONSOLIDATED FORM r TANKS <br /> i UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> (Mv pages per fang) <br /> vas• - el _ <br /> 5. CHANGEOFINFORMATION) ❑ 6. TEMPORARYSITECLOSURE <br /> TYPE OF ACTION ❑I.NEW SITE PERMIT ❑ 4.AMENDED PERMIT t ❑ L PERMAnENTLY CLOSED ON SITE <br /> ICnKt ena aam wly) Ll Al I ii <br /> •lPrleolvv araW ( BYNart9abrlwal vaeenly) 06.TANKftEMOVEO a]0 <br /> I <br /> BUSINESS NA Uma at FACI HANE w DBA•Dem98uimau Aa7 /��� <br /> FACI foo <br /> C-/LSNirJ�r -�1 9 <br /> LOl WITHINSITE(Op6ana9 <br /> L TANK DESCRIPTION <br /> V TANKMANUFACTURER COMPARTMENTALIZED TANK ❑ Yu Ne <br /> 23 /-7 / 0 �� e�n •'/, Y<i, ompl•Ie ena paLa lw aatl wmpart •n<. <br /> O4 /L/`/ /UVJ NUMBER CF COMPARTMENTS <br /> DATE INSTALLED CY RRBOI TANK CAPAl I1 IN GA-­ <br /> Q22, ilaeoa 6A LAN <br /> ADDITIONAL SLRIPTION 1%erbcM uta vnla? <br /> 11.TANK CONTENTS <br /> TANK USE A2 E ❑ 5. JET NEL <br /> � <br /> 1 REGULAR UNLEADED ❑ 2. LEADED 1. <br /> MOTOR VEHICLE NEL 9. DIESEL ❑ 6. AVIATION NEL <br /> (I/maAaO..,,'iPafm4um Tt9Q ,../ID. PREMIDN UNLEADED [I 99.OTHER <br /> ❑ 2. NON-FUELPETROLEUM to MIDGRAOEUNLEAOED ❑ 4. GASOHOL <br /> DA$/ <br /> ❑ T.CHEMIULPRGOUCi /- (6pm NuaNaui MahNlt lnvanbr/pa9e1 <br /> ,./ COMMON NAME(Imm Naiartbut MaNaalt lnwnfvrypa9e) <br /> YJ a. HAZARDOVS WASTE(IrclWea <br /> WM WI <br /> Ill.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLE W-1 ❑ O. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL SLAOOER SYSTEM _ <br /> EXTERIOR MEMBRANE LINER 095. UNKNOWN -. <br /> (CM k eN aem ANyl 2. DOUBLE WALL '04 SINGLE WALL IN A VAULT 0 99 OTHER <br /> TANK MATERIAL-Ill MnY ❑ A. BARE STEEL /0 D. FIBERGLASS I PLASTIC ❑ 5. CONCRETE <br /> ❑95. VNKNOKN <br /> (C6Kt ena item..IH ❑ 2. STAINLESS STEEL ❑4. STEEL CLAO WIFISERGLASS ❑ B. FRP COMPATIBLE WIIEGX METHANOL 0 9. OTHER <br /> eX REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-Ma nary lank I. BARE STEEL �L-I2 FISERGU ❑ST OTHERSSIPLASTIC 06 FRP COMPATIBLE WIf00X METHANOL ❑ UNKNOWN <br /> (QnKY ena aK.,,am}B ❑ 2. STAINLESS STEEL / ❑ 4. STEEL CLAD WIFIBERGLASS ❑ 9. FRP NONLORROOIBLE JACKET 9. <br /> REINFORCED PLASTIC(FRP) 010 COATED STEEL <br /> in 5. CONCRETE DATEINSTALLEO <br /> TANK INTERIOR LINING 1, RUBBER LINED ❑ 5. EPDXY LINING 5. GLASS LINING 09m. UNKNOPda96 <br /> OR COATING 0 4 PHENOLIC LINING ❑ B. UNLINED ❑99. OTHER (FerKKal ma pnh) <br /> ❑ 2. ALKYD LINING DATEINSTALLEO <br /> Nct Prra Bam ) 95 <br /> OTHER CARROSION ❑ 1 MANUFACTURED CATHODIC ❑ 2. FIBERGLASS REINFORCED PLASTIC �99.OTHERS a <br /> PROTECTION IF APPLICA9 E PROTECTION ❑ 4. IMPRESSED CURRENT (Fwbal vaa Only) <br /> (CN6 al 2. SACRIFICULANOGE OVERFILL PROTECTION EQUIPMENT,YEAR INSTALLED <br /> ShIL ANOOVE0.FILL EAR INSTALLED TYPE(Fwbealuta-W <br /> ?.CO 1.ALARM 5. fILLNBE SHUT OFF VALVE <br /> R`nKY ae mat appy) TA <br /> 2. BALL BOAT O I.EXEMPT <br /> 1. DR E <br /> ❑ O. STRIKER PLATE <br /> N.TANK LFAK DETECTION <br /> IF GOUSLE WALLTANK OR TANK WITH BUDDER(CNKY wa�nm aMy). <br /> WSINGLEWALLTANK aB I»afa L 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 1. VISUAL(EXpGSEO PORTION ONLY) ❑ S. MANUALTANK GAUGING(MTG7 <br /> ❑ 6. VADOSE LONE 1 CONTINUOUS INTERSTITIAL MONITORING <br /> x1 AUTOMATIC TANK GAUGING(ATG) T GROUNDWATER ❑ G. MANUALMONITORING <br /> ❑ ]. CONTINUOUS ATG <br /> ❑ l STATISTICALINV NTORY RECONCILIATION(SIR) ❑ 6. TANKTESTING <br /> BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRAI01GAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING <br /> 425 TANK FILLED WITH INERT MATERIAL? <br /> -�9aGant ❑Yat ❑NP <br /> Fc"edy SWRCS Form E <br /> CUPAFOP.M(4199) <br />