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ewmm PROGRAM CONSOLIDATED FLO TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (T- wsa LIQ lank) fie- of TYPEOF ACTION ® 1. NEW PERMIT ❑ 4. AMENDED PERMIT 13 5. CHANGE OF INFORMATION ❑ 6. TEMPORARY TANK CLOSURE 45e (Cbrk.s -*) ❑ 3. RENEWAL PERMIT Q W t49lt C aA N 4(✓ ❑ 7. PERMANENTLY CLOSED ON SITE (Spd ,--* (sp-y) ❑ S. TANK REMOVED BUSINESS NAME(smr FACEEM NAME m MIA- D--i-sE wM) ]. FACILITY IP. 1. L l r,) o I -M M A aK L -r t^ I v o 0 3 s g l LOCATION W DIIN SITE (OPb.0 431. $Zo3 E ttwy 2. Ca 5'roGK-rotil - LA s"T L TANK DESCRIPTION (A sled plot plan with tbo locat)m of the UST system iwkmiimg htil&p and Ledaub shill be mLmitW to the IoDW .) TANK ID k 432 TANK MANUFACTURER 431 COMPARTMENTALIZED TANK Ya U No 454 I r'rtoDeR&l(A)fcZD1J! IY.^aRlw®pa.tr�km�.mot DATE INSTALLED 435. TANK CAPACH'Y IN GALLONS 436 NUMBER OF COMPARTMENTS (YEAR/MO) uK� Do I�( u7. 1 ADDHTONAL DESCRIPTION (F -I -d s miy) G& IL TANK CONTENTS TANK USE M PETROLEUM TYPE 41a 10 1. MOTOR VEHICLE FUEL la REGULAR UNLEADED ❑2 LEADED 135. JET FUEL (Ede-b-k°0°v�PrINaw71/9r) ❑Ih PREMIUM UNLEADED 03. DI&ffi. [16. AVIATION OAS ❑ 7 NON-FUELPERtOLEUM 13 1- MIDGRADE UNLEADED I]4. GASOHOL 099. OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (6m N4ados t6veY lw�ory par) ul. CA$# (sin Rvdoa N11oY lew.mkypep) w2 ❑ 4. HAZARDOUS WASTE psi G R -50c( kiE - ❑ 95. UNKNOWN HL TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL 0 1 SINGLE WALL WITH EXTERIOR 0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM wl (Clskk.iwmody) MEMIHRANELINEk 13 95. UNKNOWN . DOUBLE WALL 4. SINGLE WALL IN A VAULT 99. OTHER TANK MATERIAL -pme•y ilk 1. HARE S'TBBf. 3. FIBERGLASS/PLASTIC 03. CONCRETE ❑ 93. UNKNOWN 44a (Cook®ole aeh) ❑1 STAINLESS STEEL - 94. STEEL. CLAD V//FmGLA33 [3 S. FRP COMPATIBLE 13 99 OTHER REINFORCED PLASTIC ) W/100%METHANOL TANK MATERIAL -memdwytdc 1. BARE STEEL C33. FIBEROIASS/PLASTIC 0 8. FRP COMPDELE W/100% METHANOL E3 95. UNKNOWN u5. (Chink me mem only) ❑ 2. STAINLESS STEEL 54 STEEL CLAD W/FTBffiiGLASS ❑ 9. FRP NON-CORRODARI JACKET El 99. OTHER REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL rl 5. CONCRETE TANK INTERIOR LINING 1. RUBBER LINED U 3. EPDXY LINING 5. GLASS LI NG 95, UNKNOWN 416 DATE INSTALLED u7. OR COATING ❑ 1 ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 6. UNLINED ❑ 99. OTHER (Chvrk om rom ) OTHER CORROSION 1. MANUFACTURED CATHODIC 3. FIBERGLASS REINFORCED PLASTIC 95. UNKNOWN 446 DATE INSTALLED u9. PROIB(.7[ON PROTECTION ❑ 4. IMPRESSED CURRENT [3 99. OTHER A Y 2. SACRIPCW. ANODE SELL AND OVERFILL YEAR]]ffIISCALD 456 (Chad[ dl thG apply) 1. SELL CONTAINM@TT TYPE 451. h1 I +16_ OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 432 ALARM $2. DROP TUBE a_ OU �p o 1, w 51. ® 3. FILL TUBE SHUT OFF VALVE - ❑ 2. BALL FLOAT ❑ 4. EXENPC 3. STRUM PLATE �A _ N. TANK LEAK DETECTION (A dosaription of the mowtonag prognan dmI he rahmitled to dw lead .) IF SINGLE WALL TANK 451 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Chert .0 tbt RPh) (Check oae IDem mly) ❑ 1. VIS(JAL (EDGOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING (MTO) ❑ 1. VISUAL (SINGLE WAIL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING (ATO) ❑ 6 VADOSE ZONE [12. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUS ATO ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING 4. STATISTICAL INVENTORY RECONCILIATION ❑ 8. TANK THSRNO (SIR) + BIENNIAL TANK TESTING ❑99. OTHER V. TANK CLOSURE WFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YRAIO/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATMUAL? 457. PD® ❑ Ya ❑ No UPCF hw& b (1/99) -1/4 htlpUt w .tnldoea.erg Rn. 0J16100