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F UNIFIED PROGRAM CONSOLIDATED FOR �� ETANKSNDERGROUND STORAGE TANKS -TANK P40 AGE 1 rfark) <br /> Pa9a al <br /> TQC 5 _71 <br /> ❑ 5.CNANGEOF INFORMATION) ❑ B. TEMPORARY SITE CLOSURE <br /> 1.NEW SITE PERMIT (34.AMENDED PERMIT ❑ T. PERMANENTLY CLOSED ON SITE <br /> ttPEOFACNON <br /> (Check one ilem only) �� S hergr-brlocal me only) ❑ B. TANK REMOVED tl0 <br /> ❑3RENEWAL PERMIT SWMmuon-lorlaalupony) IP..dyc <br /> FACILITY ID a ' <br /> BUSINESS NAME(Same as FACILITY NAME or OM-Going Buimess As <br /> R{ 6 SCL v <br /> LOCATION WITHIN SITE( PYOA 4 ,], J.'5 1� <br /> Nor t 4- �v►L*V <br /> 1.TA KDESCRIPTION <br /> COMPA0.TMENT2E <br /> Me <br /> TANK MANUFACTURER Y.' ws <br /> mpleb one page fo�aNcomDanmeel. <br /> TANK ID N u N K N o w n) <br /> NUMBER OF COMPARTMENTS <br /> TANK CAPACITY IN GALLONS <br /> DATEINSTALLED(YEAWMO) <br /> uNvA Lotj tJNlfAlo.rw 5 <br /> ADDITIONAL DESCRIPTION/Forlocat me oMy) <br /> it.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE - ❑ 2 LEAOEO ❑ 5. JET FUEL <br /> ❑ta REGULAR UNLEADED ❑ ] DIESEL ❑0/y. AVIATION FUEL <br /> ❑ t MOTOR VEHICLE FUEL ❑tU PREMIUM UNLEADED egg. OTHER <br /> (II manlsq comP�le prfmleum Type) ❑ 4, GASOHOL <br /> ❑ 2. NON-FUEL PETROLEUM C]I.. MIWMOEUNLEADED CAB N(/mm Nazad°us Mafedals lmm�rory page) <br /> ❑ ].CHEMICALPROOUCT COMMON NAME(fmm Hasanlaus MafrMls Inventory Page) <br /> ❑ ,. N,,ARODUS WASTE(Ieclutlre <br /> Usee Ol <br /> III.TANK CONSTRUCTION <br /> ❑ ]. SINGLE WALL WITH ❑ S. SINGLE WALL WITH INTERNAL BUDDER SYSTEM <br /> WPEOFTANK I. SINGLE WALL - EXTERIOR MEMBRANE LINER [2 95, UNKNOWN <br /> (Check one item enM ❑ 2. DOUOLEWALL ❑ A SINGLE WALL IN A VAULT 099. OTHER <br /> C]95. UNKNOWN <br /> TANK MATERIAL-Phnary lank OIL BARE STEEL ❑ ]. FIBERGLASS/PLASTIC <br /> ❑ 5 99. OTHER. CONCRETE❑,� STEEL CLAD WIFIBERGLASS ❑ B FRP COMPATIBLE Val 100%ME <br /> ❑ 2. STAINLESS STEEL THANOL ❑ <br /> (Cnack one ilem oMy) REINFORCED PLASTIC(FRP) <br /> 95, <br /> TANK MATERIAL-s¢ondary tank Cl 2 BARINLESS <br /> ❑ 1 FIBERGLASS I PLASTIC ❑ B. FRP COMPATIBLE WI,OO%METHANOL C]99 OTHER <br /> E STEEL <br /> ET <br /> FRP <br /> (Check ane item Only) ❑ 2. STAINLESS STEEL ❑ ,. STEEL CLAO pLASTIRGLASS O o COATED STEEL JACK <br /> REINFORCED PLASTIC(FRP) <br /> ❑ 5.CONCRETE DATE INSTALLED <br /> ❑ ]. EPO%Y LINING ❑ 5. GLASS LINING 095. UNKNOWN,]] <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED �8 UNLINED 099. OTHER (Fa/Iaal use on 1 <br /> 0RCOATING ❑ 2 ALKYD LINING ❑ ,. PHENOLIC LINING DATE INSTALLED <br /> ,], <br /> (Check an.item on <br /> ❑ s. MANUFACTURED CATHODIC ❑ ]. FIBERGUSS REINFORCED FUSTIC 95. UNKNOOTHER AI <br /> OTHERCION IF PP PROTECTION ❑99. OTHER /Fo/Iecel use°nN1 <br /> PROTECTION IF APPLICABLE ❑ ,. IMPRESSED CURRENT <br /> YEAR INSTALLED TYPE(Fo/lacal use only! OVERFILL PROTECTION EQUIPMENT'.YEAR INSTALLED <br /> (GMck ane dem oNy) ❑ 2. SACRIFICIAL ANODE <br /> SPILLAND OVERFILL [3ALARM [1 ]. FILL TUBE SHUT OFF VALVE <br /> (CMckallfhsf Ply) I, SPILL CONTAINMENT ,J P` �— <br /> Cl 1 <br /> �— ❑ 2. BALL FLOAT E% <br /> ❑ a. EMPT <br /> ❑ 2. 00.0P TUBE <br /> ❑ ]. STRIKER PUTS �J=� '�- <br /> - N.TANK LEAK DETECTION <br /> IF DOUBLEWALLTANK ORTANKVATII BLADDER Check am item an 1: <br /> IF SINGLEWALL TANK heekrPMal• 5. MANUAL TANK GAUGING(MTG) ❑ s. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ <br /> ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 2. CONTINUOUS INTERSTITIAL MONITORING <br /> VAM <br /> ❑ e. GROUNDWATER <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATC) Cl ]. MANUAL MONITORING <br /> ❑ T. GROUNDWATER <br /> ❑ 1 CONTINUOUS ATG ❑ S TANKTESTING <br /> ❑ ,. STATISTICAL INVENTORY RECONCILIATION(SIR)a <br /> BIENNIAL TANK TESTING ❑99. OTHER ��� <br /> Y.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN s 5�O TANK FILLED VATH INERT MATERIAL? <br /> ESTIMATED DATE UST USED(YRIMOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING ❑No <br /> 8� 4 --gtllenr ❑Y.e <br /> FormeAy SWRCR FL <br /> CUPAFORM(4/99) <br />