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r. <br />UNIFIED PROGRAM CONSOLIDATED Fk..,M <br />TANKS <br />UNDERGROUND STORAGE TANKS - TANK PAGE 1 <br />(T- ma pQ Unk) <br />Paga - of - <br />TYPE OF ACTION 1. NEW PERMIT [14. AMENDED PERMIT 5. CHANGE OF INFORMATION ❑ 6. TEMPORARY TANK. CLOSURE 431 <br />(Ch. k Dasa mb) ❑ 3. RBNSWAL PERMIT A�5 w�IFb (I ft� AS[ ❑ 7. F RiMANUNMY CLOSED ON SITE <br />(BP.*...w ❑ S. TANK REMOVED <br />BUSINESS NAME (9. r FAca=mAw amA-D®aB A.) 3. <br />FACB.ITY IU <br />1. <br />L N'DE rn E <br />s^RooO <br />35-`1 <br />i <br />LOCATION WI'T'HIN SITE (clpb oD ul. <br />2 E f%W 2 5T-0 Qe-Fe)Al UST <br />L TANK DESCRD'TION <br />(Asc"pbtpbnwA*AbombmcfthoUSrsystemiwbtdmgWAfin and laodmub 66x11 be eub�miCad to the local <br />TANK ID N a2 <br />TANK MANUFACTURER 42i <br />COMPARTMENI'AI.)7ID TANK aYm ❑ No 4x <br />3 <br />MODE -&N wEL-DING <br />IfwW ..gift ., ft. <br />DATE INSTALLED a5. <br />TANK CAPACITY IN GALLONS 436 <br />NUMBER OF COMPARTMENTS <br />(YEAR/MO) U K <br />5- 00o <br />437. <br />z_ <br />ADDITIONAL DESCRIPHON Wabw-w)j <br />438 <br />II. TANK CONTENTS <br />TANK USE 43A <br />PETROLEUM TYPE <br />L MOTOR VEHICLE FUEL <br />44a <br />[3 1. REGULAR UNLEADED 02 LEADED 05. NET FU13L <br />(HcL'�4 w-pi"PaoYwTIM) <br />alb, PRE IUMUNLEADED ❑3. Dom. ❑ 6. AVIATION OAS <br />❑ 2 NON-FUHL PETROLEUM <br />❑ la MADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER <br />❑ 3. CHEMICAL PRODUCT <br />COMMON NAME (6wlmJoet 34.m,tial. iv..evF PP) ul. <br />CASH (6m 114,adme. N./ttak lm�yT�) H3 <br />❑ 4. HAZARDOUS WASTE <br />(hcd. UW 01D( <br />G A SoC,t is E <br />o b o L <br />1395. UNKNOWN <br />III. TANK CONSTRUCTION <br />TYPE OF TANK L SINGLE WALL 3. M40LE WALL WITH MCIERIOR 5. SINGLE WALL WITH RjT-W AL BLADDER SYSTEM 442 <br />(Chrlk com iemm mly) MEMBRANE LINER ❑ 95. UNKNOWN <br />2 DOUBLE WALL 4. SINGLE WALL IN A VAULT 99. OTFiHR <br />TANK MATERIAL -po�yet.k 1. BARE STEEL 3. F®MGLASS/PLASTIC ❑5. CONC MN ❑ 95. UNKNOWN 44l <br />(b4eM m wl) ❑ 2 STAINLESS STEEL 04. STffi. CLAD W/[IBffitGLASS ❑ 8. FRP COMPATIBLE ❑ 99. OTHER. <br />REINFORCED PLASTIC(FRF) WA 00% METHANOL <br />TANK MATERIAL-.eomdvymh 1. BARE STEEL 3. FIBERGLASS/PLASTIC 8. FRPCOMPTIBLEW/100%mETHANOL 95.UNKN0WN 445. <br />(Check aro emm mly) ❑ 2 STAINLESS STEEL ID5. STEEL CLAD WIFIHE RGLASS ❑ 9. FRP NON�CORRODABLE JACKET ❑ 99. OTHER <br />REINFORCED PLASTIC (FRP) 13 IOL COATED STEL <br />5. OONCRHIE <br />TANK INTERIOR LINING E3 1. RUBBER LINED 3. EPDXY LINING 5. GLASS LINING 95. UNKNOWN 446. <br />DATE INSTALLED u7. <br />OR COATING ❑ 2 ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 6. UNLINED ❑ 99. OTHER <br />((]heck ®Tem ) <br />OTfffiR CORROSION 1. MANUFACTURED CATHODIC 0 3. FIBERGLASS REINFORCED PLASTIC 0 95UNKNOWN ua <br />DATEINSTALLED u9. <br />PA078LTION PRTION❑ 4. IMPRESSED CURRENT 13W OTHER <br />2 SACRIFICIAL ANODE <br />SPILL AND OVERFILL YEARINSTALLED 4% <br />(Check W dK.pply) IB 1. SP1LI, CONTAINMENT i��S <br />TYPE 45l <br />I �-1fC <br />OVERFILL PROTHCTIONEQUIPMHNf: YEAR INSTALLED 432 <br />Sl. ALARM W3. FILL. TUBO SHUT OFF VALVE <br />® 2. DROP TUBE _�gSjZ <br />W I.3 <br />_ <br />132 HALL FLOAT ❑ 4. EMdPT _ <br />3. STRDOM PLATE <br />_ <br />IV. TANK LEAK DETECTION <br />(A domoriptkm of the mandm=g propsom .hal be wbm. to the bael .) <br />IF SINGLE WALL TANK 455. <br />IF DOUBLE WALL TANK OR TANK WITH BLADDER 44 <br />(C'bK k aB d* apply) <br />((:rhmdk ® vom aaly) <br />❑ 1. VISUAL (HGV SED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING (MTG) <br />❑ 1. VISUAL (SINGLE WALL IN VAULT ONLY) <br />❑ 2. AUTOMATIC TANK GAUGING (ATG) ❑ 6. VADOSE ZONE <br />❑ 2. CONTINUOUS NNTEmsTmAL MONITORING <br />❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER <br />❑ 3. MANUAL MONITORING <br />04. STATISTICAL INVENTORY RECONCILIATION 08. TANK TESTING <br />(SIR)+BIENNIAL TANK TESTING ❑ 99. OTHER <br />V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE <br />ESTIMATED DATE LAST USED (YR2T0/DAY) ISS. <br />ESTIMATED QUANTrrY OP SUBSTANCE Hl3fAINA'G 456 <br />TANK FnJ ED WITH INERT MATERIAL? 437. <br />8all® <br />❑ Yet ❑ No <br />UPCF hwM1.kc-b(M-L4 httpd/ry .,mNoeaorg Rev. OV16CB <br />