BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

e-26-202 os: �(6 2 UNIFIED PROGRAM CONSOLIDA D FORM J/ UNDERGROUND STORAGE TANKV icp OPER NG PERMIT APPLICATION-TANK INFORMATION(ono faun usT(( T E OF ON (Chockoe.item only, For an UST Permanent cl99mro or removal,complete only this section end$actions ❑ 1.t4Hw PRRna _" J RMIT 3.RENEWAL PE5.CHANGEOF INFOL II,III, to RMATION and IX STI a]o 6.TEMPORARY UST CLOSURE 7,UST PERMANENT CLOSURE ON SITE I B.USI'REMOVAL DATE UST PERMANENTLY CLOgRD: = 13=E IDUSTING UST DISCOVHRED: 430e RMATION FACILITY 1D p(Agtrtty Uze 0,1y) I. FACILITY INFO _ _ I BU� AM81(3 as FACILI N E or D A-Doing Business AS) S W 3 8US7NEpgSI'LE D RE (� �m 103 CITY 104 II.TANK DESCRIPTION TANK@tl m7 TANK MANUFACTURER 4]] TANK CONFIGUkATTON:THIS TANKD (� I/,, /,. `p�''t 1.A STAND-ALO " NG TANK 471 44- kow t IJ 2.ONHIN A COMPARTMENTED MT. DATE ST SYRTEM INSTALLED 4u TANK CAPA IT Gm Gia me etoremb aa0anl In(heel e e . N ALL S 430 NUMBER OF COMPARTMENTS IN THE UNIT w] 4 III.TANK E AND CONTENTS. TANK USH LJ Is,MOTOR VEHICLE FUELINO ❑ Ib.MARINA FUELING ❑ 3.CHEMICAL PRODUCT STORAGE ❑ Ir.AVIATION FUELING 439 fi,OTHER GENERATOR FUEL ❑ 4.HAZARDOUS WASTE DeCle6e9 usm 011) ❑ S.EMERGENCY GEN T R • ci 1.5(c)� CONTENT$ PETROL ED 9S.UNKNOWN 99 OTHER(SP&4. EIfM� Ll 3,DIESEL UNLEADED 17 Ic.MIDORADEUNLEADED D C 4]94 ❑ ],DIESEL 5.JET FUEL ❑ Ib.PRSMIUMUNII IEU S.PETROLEUM BLEND FUEL 9.OTHER PETROLEUM 6,AVIATION GAS / Vr �� 440 NON-PEtkOLEIIM: Q 7.USED OIL Sec! Tr sa0e !] [O.ETHANOL II.OTHER NON-PETROLEUM S IV. TANK CONSTRUCTION 4406 TYPE OF TANK 1.SINGLE WALL ❑ 2.DOUBLE WALL 95,UNKNOWN PRIMARY CONTAMMENT 7,STEEL J.FIBERGLASS e.INTERNA{, 7.,STF,EL.v "DOER LINING 9WB SEONbYCDNAINMENC 3.FIBERGLAg9 6EXN 99.p } R OR 444. 90.NONE ❑ 93,UNKNOWN 99.OT74ER(S eoi LINER 7.IACKETEO W OVERFILL PREVENTION I.AUDTBLEll, $VISUAL ALARMS 2.EALL FLOAT 3,PILL TUBE 919UTAFF YALVE 441. ❑ 4.TANK MEETS RE UfREMENTS FOR P.XEMPTION FROM OVERFILL PREVENTION EQUIPMENT 452. Y. PRODUCT/WASTE PIPING CONSTRUCTION 1 PIPING CONSTRUCTION LSINGL¢•WALLED ❑2.DOIIBLE•WALLED 99.OTHER SYSTEM T'YP¢ I,PRESSURE 2.ORAVITY 3.CONVENTIONAL$UCTTON 4.9AFb SUCTION 2]CCR 43 4SB PRIMARY CONTAINMENT 1,STEEL 4.FIBERGLASS B.FLEXIBLE ❑ 90.NONE Ll 93.UNKNOWN 10.RIGID PLASTIC W SECONDARY CONTAMMENT 1.STEEL El 99.OTHER(Spr9{ ): 464¢ 4.FIBERGLASS S.FLEXIBLE 10.RIGID PLASTIC ❑ 90,NONE ❑ 95.UNKNOWN 99.OTHER(Spud ); �' PlPWORURHINB CONFAINMEN I SUMP TYPE I.SINGLE WALL Q 2.DOURER WALL 90,NONE 464e VI.PENT,VAPOR RECOVERY R AND R1SEA/FILL PIPE PIPING CON5TAUCTIONIl 4F46 VENT PRIMARY CONTAINMENT I STEEL A.FII3ERQLA$$ 10,RIOIO PLASTIC ❑ 80.NONE 99,OD4ER(Spwify) 4614 VENT SECONDARY CONTAINMENT I.STEEL � 4.PI88ROLA99 1D.RIGID PLASTIC 9o,NGNE 99.OTI♦ER S ip VR PRIMARY CONTAINMENT I.STEEL ( pec b) 4.PIEERDLA3$ ❑ la.mDID PLASTIC 90,NDNE 99.OfHER(Spemry) 4apn VR SECONDARY CONTAINMENT L STEEL t.FIBERGLASS 10.RIGID PLASTIC eD.NONE �4 99,OTHER(SpedQ�) g646 ISE PIPING 7RANSITIONSUMPTYPE R1.9IrvOLe WALL 4c4pi RISER PRIMARY CONTAINMENT 1,$TEE4 4.FIBERGLASS 1D�OIb PlA3TC 90,NONE Ora. 90.NON99. OTH8R(Spedfy) 4 RISER SECONDARY CONTAINMENC 1.STEEL J ❑ 9.FIBERGLASS 10.RIGID PLASTIC 90,NONE 99.OTHER(Spectry) 464k FILO COMPONENTS tN3TALLEn ].SPILL BUCKET 3,STRIKERPLATN/BOTI'OMPROTECTOR 4.CONTAINMENT SUMP 451LK VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ I.SINGLE WALL [] 2.nDUBLE wwLL (] 3,NO DISPENSERS 90.NONE d69a CONSTRUCTION MATERIAL 1.STEEL A.FIBERGLASS ❑ I0.RICID PLASTIC Q 99.01'HER 3 e9 VIII. CORROSION PROTECTION Wh1 e- 4696a STEEL COMPONENT PROTECTION ❑ 2,SACRIFICIAL ANODES) ❑ y DaPRESSEDCURRENT ❑ 6.ISOLATION 44t, IX, APPLICANT SIGNATURE CERTIFICATION: 1 eertlry that this UST system Is compatible with the hazardous sobstanrn stored and and Ifulcam React wit 1 m ulremeR that the Information provided g herein is froaccurate, n l . APPLICANT SIGNATURE DATE d70 Z5 APPLICANT NAME(print) � ' ��r 1•r q71. f 2 pLI T IT 4n. V �.. r !.�„✓n.er UPCF UST•B-171 Rev.(12/2007)