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UNIREDPUNDROGRAM CONSOLIDATED O '1772727'76& ;z��n7 I7 OPERATING PERMIT APPLICATION-TANK INFORM N(One ero m mer l TYPE OF ACTION (Check one item only. For an UST pemmremoval,nwt closure or wmplete only this section and Sections I,II,II,IV,and IX below) 430 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CEIANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SfCE 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430' I DATE EXISTING UST DISCOVERED: 4306 I. FACII ITY INFORMATION FACILITY ID#(Agency Use Only) O 1 BUSINES NAME(S w FACILjTY NAME or DBA-Doin usiness As) 3 Q 1C BUS SS SITE AD S 103 C Im II.TANK DESCRIPTION TANK I)#( •/1/ (/ 432 TANK MANUFACTURER 433 /[{TTAAW CONFIGURATION: THIS TANK IS 434 -rbt 6) ' / \ v (� `(%(/�/�, LJ2.ONE i-ASTA COMPARANK TMENTED UNIT. ••J// Co deme foroch in thewu[ DATE UST SYSTEM STALLED 435 TANK CAP IN GALLONS 436 NUMBER OF COMPARTMENTS M THE UNIT 437 III.TANK USE AND CONTENTS TANK USE ❑ la.MOTOR VEHICLE FUELING 0 Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 0 3.CHEMICAL PRODUCT STORAGE 44 HAZARDOUS WASTE(6eJWa Used 0i0 El5.EMERGENCY GENERATOR FUEL[NSC 125291.5(c)]0 6.OTHER GENERATOR FUEL 95.UNKNOWN ❑ 99.OTHER(Specify): 43% CONTENTS PETROLEUM: 0 la.REGULAR UNLEADED 0 Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 0 3.DIESEL 0 5.JET FUEL 0 6.AVIATION ❑ S.PETROLEUM BLEND FUEL 0 9.OTHER PETROLEUM S /I 4404 NON-PETROLEUM:0 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406 IV.-TANKCONSTRUCTION , TYPE OF TANK I.SINGLE WALL 02.DOUBLE WALL 095.UNKNOWN 443 PRIMARY CONTAINMENT 1.STEEL 0 3.FIBERGLASS ❑ 6.INTERNAL BLADDERRTED 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN 0 99.OTHER S444a SECONDARY CONTAINMENT ❑ 1.STEEL 0 3.FIBERGLASS 0 6.EXTERIOR MEMBRANE LINER 0 ETED 445 90.NONE 0 95.UNKNOWN [199.OTHERS . 445. OVERFILL PREVENTION I.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT b 3.FILL TUBE SHUALVE 452 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQU V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED ❑2.DOUBLE-WALL® 0 99.OTHER460 SYSTEM TYPE ❑ I.PRESSURE ❑ 2.GRAVITY 0 3.CONVENTIONAL SUCTION 0 4.SAFION I23 CCR 42636(a 3) 458 PRIMARY CONTAINMENT 0 1.STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGIDSTIC 464 ❑ 90.NONE 0 95.UNKNOWN 0 99.OTHER(Specify): 4Ma SECONDARY CONTAINMENT 0 L STEEL ❑ 4.FIBERGLASS 0 8.FLEXIBLE ❑ 10.RIGSTIC 4Mb 0 90.NONE 0 95.UNKNOWN 0 99.OTHER(Specify): 4Mc PIPINGrrURBINE CONTAINMENT SUMP TYPE 0 I.SINGLE WALL 0 2.DOUBLE WALL 90.NO464d VI.VENT,VAPOR RECOVERY")AND RISER/FILL.PIPE PIP G CONUCTION VENT PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS 10.RIGIDPLASTIC 90.NONE HER(Specify) 464, VENT SECONDARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS ❑ 1 O.RIGIDPLASTIC 90.NONE 0HER(Specify) 4Mf 4MfJ VR PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS Cl 10.RIGID PLASTIC 90.NONE HER(Specify) 464g VR SECONDARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS ❑ 10.RIGD PLASTIC 90.NONE 0 99.OTHER(Specify) 4Mh 464h1 VENT PIPING TRANSITION SUMP TYPE I.SINGLE WALL 2.DOUBLE WALL 90.NONE RISER PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 0 99.OTHER(Spmify) 464i RISER SECONDARY CONTAINMENT 1.STEEL 4.FJBERGLASS 464'I 10.RIGID PLASTIC 90.NONE 99.OTHER(Spaify) 4Mk 4Mkl FILL COMPONENTS INSTALLED 1.SPILL BUCKET 3.STRIKER PLATEIBOTTOM PROTECTOR 0 4.CONTAINMENT SUMP 451. VII UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE 0 1.SINGLE WALL 0 2.DOUBLE WALL 0 3.NO DISPENSERS .NONE 464+ CONSTRUCTION MATERIAL 0 L STEEL 0 4.FIBERGLASS ❑ 10.RIGIDPLASTIC 0 99.OTHER(S ) 469b< VIIL CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) [14.IMPRESSED CURRENT 0 6.ISOLATION M6. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stared and that the information provided herein is true,accurate, and in full compliance with legal requirements. APPLICANT SIGNATURE DATE ao. APPLICANT NAME(print) 471" APPLICANT TITLE 472. UPCF UST-11-1/2 Rev.(IN2007)