BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

APR-26-2012 0904 AM10 UNIFIED PROGRAM CONS TED FORM UNDERGROUND STORAGE TANK ( l OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) azo TYPE OF ACTION (Checit one item only. For an UST permanent closure or removal,complete only this Section5.CHANGE OF INFORMATION IV,and IX below) 1.NEW PERMIT J 3,RENEWAL PERMIT 8.UST REMOVAL 6.TENDJORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE xs9n 430° DATE EISTINOUST DISCOVERED: DATE IIST PE'RMANFNTLY CLOSED: I. FACILITY INFORMATION 1 FACILITY ID If(A9CnoY Use Only) s BU� AME)(Sa asFACILI N EorD A-DoingBmineesAS) $ yylEw '03CITY C � BUSINE O RE"� ) wlSit . II.TANK DESCRIPTION 431 TANKID 432 TANK MANUFACTURER 433 TANKCONPIOUMT1UN:THISTANKIS I.A STAND-ALONG TANK 2.ONE IN A COMPARTMENTED UNIT, '^'," Com lets lvev Ter eeeh aron,nl In Ale wit. � °33 TANK CAPA ff� AL S 436 NUMBER OF COMPARTMENTS IN TRE UNIT DATE ST SYSTEM INSTALLED N _g 1 III.TANK E AND CONTENTS, 419 [] l9.AVIATION FUELING TANK USE ❑ 1%MOTOR VEHICLE FUELINO ❑ 4.HAZARD US WAO 5.BMER09NCY GEN T R _ L CA2 its(e)1 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.H UNKNOWN 99. ueW Oil) ❑ 99 OTHER Sec' ' D C 139° 6,OTHER OENEMTOR FUEL ❑ 96.I1NKNOWN JJO CONTENTS PETROLEUM: ❑ Ie.REOuL UNLEADED ❑ Vic,(FUEL UNLEADED 4.AVIATION GAS EADED J>r 1�4- ❑ 3,DIESEL y¢n.¢Ih Wop 8.PETROLEUM BLEND E1JEi. 90.ETFIANOLROLEOM 5 eri NON•pSMOLEUM: 7.USED OIL ❑ 4406 11.0THERNON-PEMOLEUM 5 IV. TANK CONSTRUCTION 4p3 TYPEOPTANK 1,SINGLE WALL [3 2.DOUBLE WALL 95,UNKNOWN 1144 PRIMARY CONTAINMENT 1,STEEL 3.FIBERGLASS 6.INTERNAL BLADDER wp 4441 7,STEEL v INTERNAL LINING 95.UNKNOWN 99.MER (S ed : 1 V W� 115 SECONDARY CONTAINMENT 1.STEEL 3,FIBERGLASS 6.EXT'ERIOR MEMB LMER 7.IACKETEO J454 90�NONE ❑ 95.UNKNOWN El 99.OTHERS 452. OVERFILL PREVENTION 1.AUDrBLE&VISUAL ALARMS 2.eAL4 FT.OAT 3.PILL TUBE 9HUT•OFF VALVE ❑ 4.TANK MEETS RE UIREMNTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION Oro PIPING CONSTRUCCION 13 1.SINGLE-WALLED ❑2.DOUBLE-WALLED 90.OTHERWE ase SYSTEM TYPE I,PRESSURE 2.ORAVITY 3.CONVENTIONAL SUCTION 109RIOID PLASTIC CV CCR 643 4" PRIMARY CONTAINMENT I.STt:M 4•FIBERGLASS A.FLEXIBLE 4541 ❑ 90.NONE ❑ 93.UNKNOWN ❑ 99.OTHER(Speci ) IO.ALGID PLASTIC 4646 SECONDARY CONTAINMENT 1.47EFL 4�FIBERGLASS 8.FLEXIBLE 46k ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99,OTHER(5,191 ): 99,NONE 904 PIPING/TURBINE CONITAINMENi SUMPTYPE L$INGLE WALL ❑ 1.DOUBLE WALL VI.VENT,VAPOR RECOVERY R AND RISER/FILL PIPE PIPING CONSTRUCTIONI1 4w. VENT PRIMARY CONTAINMENT 1.STEEL 4.PIBERGLA$S ❑ 10,RIOIOPLASTIC ❑ 90.NONE 99,OTHER(S,wib) A01I dG r VENT SECONDARY CONTAINMENT LSTEEL ❑ 4.PIB8ROLA94 10.RIGID PLASTIC 90,NONE 99.OTF@R(Speelfy) 46111 as VR PRIMARY CONTAINMENT L STEEL 4.PIBEROLASS ❑ 10.a101O PLASTIC 90,NONE 99.OTHER(Speedy) 4M.11 8 4011 VR SECONDARY CONTAINMENT I.STEEL 4.FIBEROLAS5 101RIGIDPLASTIC 90.NONE 99,OTHER(SPec4) J6a61 2.DOUBLE WALL. 90,NONE o"1. VENT PIPING TRANSTITON SUMP TYPE 1.SINGLE WALL 4 l RISER PRIMARY CONTAINMENT I.STEE4 4.PIBHROLA3S ]0.R1OlD PLASTIC 9D.NONE 99.OTFffiR(SPeclTy) 401 PIBEROLAS9 10.RIGID PLASTIC 90,NONE 99.OTHER(Specify) a4ak RISER SECONDARY CONTAINMENT 1.STEEL ❑ 4. 464k FILL COMPONENTS INSTALLED 1.9PILL BUCKET 3.STRnSER PLATP/BOTTOM PROTECTOR 4.CONTAINMENT SUMP 45I4< VII.UNDER DISPENSER CONTAIINrMENT(NO DISPHNSEA4 )0.NONE 4691 CONSTRUCTIONTYPE ❑ 1.SINGLE WALL 11 B 46964 CONSTRUCTION MATERL41. 1.STEEL 4.FiEEROLA55 ❑ 10.RIGID PLASTIC ❑ 99.01'FIER 3 ci VIII. CORROSION PROTECTION f jOk G 44, EI 6.ISOLATION STEEL COMPONENT PROTECTION ❑ Z.SACRIFICIAL ANODES) [] 4,rMpRE$SED CURRENT L le APPLICANT SIGNATURE CERTIFICATION: 1 certify lull thla UST aYatCm li compatible with the heTRrdoue eubad.n atOrod and that the Information provided hertin is true,aceura[q Rad In NII corn fiance wit 1 air ulremen .�/ �7 479. l DATE f 7 6 APPLICANT SIGNATURE � , 472. 411. PLI T IT E r /1W./..nwV APPLICANT NAME(Ont) � ' fi11`^ �J`^ Vrl Rev.(14!3007) IJPCF UST•B•12