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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> nw raaYd <br /> Pape _ a <br /> c a <br /> TYPEOFACTICH qF4. NEW SITE PERMIT ❑ 4.AMENDED PERMIT ❑ S. CHANGE OF INFORMATION) ❑B. TEMPORARY SITE CLOSURE CJ <br /> (Chock,.laa 0*) ❑ 7. PERMANENTLY CLOSED ON SRE 3 <br /> 03. RENEWAL Speo ywasm-b bWmAhYI pso yd angs- bW ow, ❑ S. TANK REMOVED dp/ble� <br /> PERMIT <br /> BUSINESS N4ME(Srne u FACILITY NAME or DBA.DorI Susaam,Aa) 3FACIUTYIDt <br /> � <br /> LOU WRHN SRE(CF&WOU NI <br /> " t7s Z <br /> I. K DESCRISMON <br /> TANKID• /I 432 TANKMANUFACTUR R 433 COMPARTMENTALIZED TANK ❑ Yea IR No q4 <br /> If Yea,.mmplot.We page fw asm mmpe M a 0. <br /> DATE (YEAAIMO) 1 a35 TANKCAPACITY INGALLDNS a36 NUMBER OF MPARTMENTS 4T7 <br /> 2001 �J VNL (S OOa <br /> ADDITIONAL DESCRIPTION(Fmluoal uea or4y) 438 <br /> II.TANK CONTENTS <br /> TANK USE 039 PETROLEUM TYPE 444) <br /> �.1. MOTOR VEHICLE FUEL WA., REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL <br /> (//ma/aee,omMtle Pofmleum Type) ❑IB. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATIONFUEL <br /> ❑ 2. NON-FUEL PETROLEUM <br /> ❑ 3. CHEMICAL PRODUCT ❑tc. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑W. OTHER <br /> ❑ 4. NAZARDO)S WASTE(IMUEee COMMON NAME(/m Hahahows Mahsr s Inaenfnrypaga) At CAS M(hoe HiSallous MafeeMa Inwn(wypage) 42 <br /> Uses 00 <br /> ❑95. UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL MTN ❑ S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM Kq <br /> (Chad me hem oNyf N�2. DOUBLE WALL EXTERIOR MEMBRANE LINER 1195. UNKNOWN <br /> ❑ 4. SINGLE WALL IN A VAULT <br /> ❑98. OTHER <br /> TANK MATERIAL-primary tank '61. BARE STEEL ❑ 3. RBERGUSS I PLASTIC ❑ 5. CONCRETE 095. UNKNOWN 441 <br /> (clMhI* saamoNy) ❑ 2_ STAINLESS STEEL ❑ 4. STEEL CLAD ❑ 8. FRP COMPATIBLE W/1W%METHANOL ❑9g. OTHER <br /> WIFIBERGLASS <br /> o REINFORCED PLASTIC FRP <br /> TANK MATERIAL-seccneary Md❑ 1 BARE STEEL y.3. FIBERGLASS I PLASTIC ❑ 8. FRP COMPATIBLE WIIW%METHANOL 095. UNKNOWN u5 <br /> (Check we herr only) ❑ 2. STAINLESS STEEL ❑ 4 STEE_CLADWIFIBERGLASS ❑ 9. FRP NON-CORROO(BLE JACKET 09. OTHER <br /> REIN'ORCEO PLASTIC(FRP) 1110 COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN dab DATE INSTALLED W <br /> OR CMTING to <br /> ❑ 2. ALy. <br /> ALKYD UNING ❑ <. PHENOLIC LINING 8. UNLINED 1199. OTHER <br /> Coed me4em oM Forlool use eM <br /> OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC 113. FIBERGLASS REINFORCED PLASTIC 095. UNKNOWN 446 DATE INSTA.ILED. u9 <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ I. IMPRESSED CURRENT 11 W. OTHER <br /> (Check mortem oMy) ❑ 2. SACRIFICIAL ANODE (Forlomluse oMy) <br /> SPILL AND OVERFILL YEAR INSTALLED 450 „PE(Forlool use only) 451 OVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED `452 <br /> (CkecW <br /> kmar.wy) �'aI 1. SPILLCONTAINMENT Zx <br /> 0�I ❑ 1. ALARM �' . FILL TUBE SHUT OFF VALVE 1001 <br /> p 2. DROP TUBE 7-t.701 ❑ 2. BALL FLOAT 4 EXEMPT <br /> 5.3. STRIKER PLAot Z.Co( <br /> a N. TANK LEAK DETECTION <br /> IF SINGLE WALL TANK(Check au that aody) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Chad hne ham only): 454 <br /> ❑ 1. NSLAi(EXPOSED PORTION ONLYI ❑ 5. MANUAL T::.K GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 2. AUT,CMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZCNE �2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDW'AT'ER ❑ 3. MANUALMONITORING <br /> ❑ 4. STc'151ICAL INVENTORY RECCNCILATION(SIR)- ❑ 6. TANKTEST:NG <br /> BIENNIAL TANK TESTING 09. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATE-,_ATE LAST USED(YRIMOOAY) 455 ESTIMATED QUANTITY Cr SUBSTANCE REMAINING 456 TANK FILLED NTH INERT MATERIAL? 457 <br /> galbns ❑Yea ❑No <br /> UPCF(3;99) • 0 <br /> Famerly SWRCS Form 8 <br />