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;k iill ZIED PROGRAM CONSOLIDATED FOIA TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page 1]of43 TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (mak only nem-fly) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT ❑8TANK REMOVED 430 1 � BUSINESS NAME(Sata as PACILITY NAME or DBA-wing Business As) 3 FACIl.1Ili Li: FA0003555 AMERICAN MOULDING&MILLWORK L� LOCATION WITHIN SITE(Dq+onaq 4k PHONE LT ANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agrncy.) TANK ID# �` 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No x O��b If"Ya". Itte one pi for eacM1w t. D TE STALLED(YEAK/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1 300 ADDITIONAL DEION(Por wed uve onyZ ° c31 a 2 �0 11.TANK CONTENTS TANK USE 43y PETROLEUM TYPE ❑ 1.MOTOR VEHICLE FUEL ❑ Is.REGULAR UNLEADED ❑ 2.LEADED ❑ S.JET FUEL (Ifmvked c°"yln°Pctr°Icmn iypc) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL [:12.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ® 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(bom Hazurdoua Materials Inventory page) 4ql CAS#(boo,Hamrdom mai Ini page) 442 [14.HAZARDOUS WASTE (Ini used Ca) El 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one km only) EXTERIOR MEMBRANE LINER El 95,UNKNOWN ❑ 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary lank ❑ 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Check one item ordy) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W(FIBERGLASS ❑ 8.FRP COMPTIBLE W/100/o METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Ch«t one nem only) ❑2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE WILWI.METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ I RUBBER ISNED El3.EPDXY LINING ❑ 5.GLASS LINING El 95,UNKNOWN 446 DATE INSTALLED �] OR COATING (Check one nem ong) El ALKYD LINING ❑4 PHENOLIC LINING El UNLINED ❑ 99 OTHER For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 449 DATE INSTALLED M9 PROTECTION IF APPLICABLE PROTECTION El(Chock one aan only) 4 IMPRESSED CURRENT ❑ 99 DTFIBR ElSACRIFICIAL2 SACRIFICIAL ANODE (Fm tical use oNv) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(tical us ooIy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (CLeek ag thu will ❑ I SPILL CONTAINMENT ❑ I ALARM ❑ 3 FILL TUBE SHUT OFF VALVE ❑ 2DROP TUBE ❑ 2BALL FLOAT ❑4EXEMPT ❑ 3 STRIKER PLATE IV.TANK LEAK DETECTION(A deet igion ofthe monitoring progmo,shall be submitted to the local o,i IF SINGLE WALL TANK(Chak all dw apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chak one item only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ❑2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑ 3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YRMIO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 Mons ❑Yes ❑No UPCF(12/99 revised)