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IED PROGRAM CONSOLIDATED FOR,..., UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,I{Ill,!V,and IX below) 430. ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: DO- I DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID 4(Agency Use Only) - - 1. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3_ MCI,doing business as, Verizon Business BUSINESS SITE ADDRESS103. CITY 10a 2500 W. Turner Road Lodi IL TANK DESCRIPTION TANK ID N 012- TANK MANUFACTURER 413- TANK CONFIGURATION:TI IIS TANK IS 434. 1 Owens Coming 0 1.A STAND-ALONE TANK Complete one p.gc for.6g mem in the 0 2.ONE IN A COMPARTMENTED UNIT wmpaowet. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS IN THE UNIT 437. April 1991 4,000 1 III. TANK USE AND CONTENTS TANK USE 0 la.MOTOR VEHICLE FUELING 0 Ib.MARINA FUELING 0 Ic.AVIATION FUELING 439' 0 3.CHEMICAL PRODUCT STORAGE 0 4.HAZARDOUS WASTE(Include.U.ei Oil) 0 5.EMERGENCY GENERATOR FUEL[HSC 4253815(.)] 0 6.OTHER GENERATOR FUEL [_95.UNKNOWN Ej 99 OTHER(Specify): 439a CONTENTS PETROLEUM: 0 la.REGULAR UNLEADED 0 Ic.MIDGRADE UNLEADED 0 lb.PREMIUM UNLEADED 040- 0 3.DIESEL 0 5.JET FUEL 0 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL 0_9.OTHER PETROLEUM 5_cify: 440a. ..........___-___ .................._--........--"--.. ___. De_� NON-PETROLEUM:�] 7.USED OIL 0 16.ETHANOL 0 11.OTHER NON-PETROLEUM(Specify): 4006, IV. TANK CONSTRUCTION TYPE OF TANK 0 1.SINGLE WALL 0 2.DOUBLE WALL 0 95.UNKNOWN 443. ____ .......... _ _.. ....-6.- -.. _.._ ....__. .. ............ ........_._.- ......... .. .... PRENARY CONTAINMENT ❑ I.STEEL ® 3.FBERGLASS ❑ 6.INTERNAL BLADDER aa4_ 0 7.STEEL+INTERNALLINING 0 95.UNKNOWN 0 99.OTHER(Specify): 444% ..._.._-_______.____ ...................-__.____.EXTERIOR _.......--_ ......... SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. 0 90.NONE 0 95.UNKNOWN 0 99.OTHER(Specify): _use. OVERFILL PREVENTiCN ® 1.AUDILE&VISUAL ALARMS ❑ 2 BALL FLOAT 0 3.FILL TUBE SHUT-OFF VALVE 4sz. _ 0 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION 0 1.SINGLE WALL 0 2.DOUBLE WALL 0 99.OTHER4w SYSTEM TYPE 0 1.PRESSURE 0 2 GRAVITY 0 3:CONVENTIONAL SUCTION 0 4 SAFE IS [23CCR gz 36(H3)] 458 PRIMARY CONTAINMENT 0 1.STEEL ❑ 4.FIBERGLASS ® 8.FLFJCBLE 0 10.RIGID PLASTIC 460. 0 90,NONE 0 95.UNKNOWN 0 99.OTHER(Specify): _464..__ SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ® 8.FLEXILE ❑ 10.RIGID PLASTIC 4646. 0 90.NONE 0 95.UNKNOWN 0 99 OTHER(Specify): 464a PIPINGTURBINE CONTAINMENT SUMP TYPE 0 1 SINGLE WALL 0 2.DOUBLE WALL 0 90.NONE 464a. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 0 1.STEEL ® 4.FIBERGLASS 0 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify): gbge�' _.......... ._........ ._............................_-__ ........ __. 4464E VENT SECONDARY CONTAINMENT 0 L STEEL 0 4 FIBERGLASS 0 10.RIGIDPLASTIC El 90.NONE 0 99.OTHER(Specify): 44M VR PRIMARY CONTAINMENT 0 1.STEEL 0 4 FIBERGLASS 0 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify): 464g- 46 gL VR SECONDARY CONTAINMENT 0 LSTEEL 0 LFIBERGLASS 0 JILRIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify): 4=1 -- __ __ _.............--"- VENT PIPING TRANSITION SUMP TYPE 0 1.SINGLE WALL 0 2.DOUBLE WALL 0 90.NONE ........._..Y CONTAIN .........___ - ........ _ ..... _ RISER PRIMARMENT 0 1.STEEL ® 4.FIBERGLASS 0 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify): RISER SECONDARY CONTAINMENT 0 L STEEL 0 L FIBERGLASS 0 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify): 446466k1._ ........... . FILL COMPONENTS INSTALLED 0 1 SPILL BUCKET El STRIKER PLATE/BOTTOM PROTECTOR 0 4.CONTAINMENT SUMP 4$le-c VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL 0 UBLE 2.DOWALL ® 3.NO DISPENSERS 0 90.NONE 469.. 6_ CONSTRUCTION MATERIAL 0 1.STEEL 0 4.FIBERGLASS 0 10.RIGIDPLASTIC 0 99.OTHER(Specify) 469 VIII. CORROSION PROTECTION STEEL COMPONENT PROTECIION 0 2.SACRIFICIAL ANOD S 0 4.IMPRESSED CURRENT 0 6.ISOLATION 008 IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate,and in full com iinure with legal requirements. APPLICANT SIGNATURE DATE 5/3/2010 470 APPLICANT NAME(print) Todd Harris 41L APPLICANT TITLE Regional Environmental Manager 472 UPCF UST-B Rev.(12/2007)-12 vvww.0 fldocs.org