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Oct 23 06 12: 10P 209:41-0142 �� VA <br /> p. 4 <br /> #° UNIFIED PROGRAM CONSOLIDATED FORM <br /> p TANKS <br /> UNDERGROUND STORAGE TANKS- TANK PAGE 1 <br /> (Two pages per tank) <br /> Page_of_ <br /> TYPE OF ACTION Q I.NEW PERMIT Q 4.AMENDED PERMIT 0 5-CHANGE OF INFORMATION Q 6.TEMPORARY TANK CLOSURE 450 <br /> (L k o®hcm wly) 3.RENEWAL PERMIT Q 7.PERMANENTLY CLOSED ON SITE <br /> (Syciry anion) (Speci(yream) Q &TANK REMOVED <br /> BUSINESS NA.ME(Bvne s FA61UTY NAME nIWA-Dons B.imn Az) 1. FACILITY ID: <br /> LOCATION WITHIN SITE(Cpr" +,t <br /> 'i'7 H 1 Q1�sf 4-ar e S to cJc To r) <br /> LrTANK DESCRIPTIONS <br /> Ascaledplct lenwi!h[lielocotionofthe-Uni9 t=hlcludin"buiW- andlendmarksshallbeeabrnitWdtathe focal Be <br /> TANKOIg Air 652 TANK MANUFACTURER +D COMPARTh[ENTAL[ZED TANK LF s C7 No a14. <br /> W D If'Yct'complCccrc WBc for�r6cOmryrvYN <br /> DATE INSTALLED 435. 1 TANK CAPACITY IN GALLONS 416 NUMBER OF COMPARTMENTS <br /> OTAR/MO) ' 437. <br /> t <br /> 1�2aaa <br /> ADDITIONAL DESCRIPTION(Per I w ux ml» 411. <br /> IL TANIC.CONTE.NTS <br /> TANKUSE 439. <br /> PETROLEUM TYPE <br /> Dk 1. hf070A VEHICLE FUEL IR 1.REGULAR UNLEADED Q 2. LEADED ❑S. JET FUEL <br /> (ucncd,w,romvkle 2ewleum iype) 0lb.PREMIUM UNLEADED Q3.DIESEL ❑6. AVIATION GAS <br /> 0 2.NON-FUEL PETROLEUM ' 0 1c. MIDGRADE UNLEADED Q 4.GASOHOL ❑99.OTHEA:_ __ <br /> Q 3. CHEMICAL PRODUCE COMMON NAME (rtom HamNaa;Mvclab lwwmypaee) 441. CASE(etmti:mNaus bbieiab lnvmwry pig) 441 <br /> Q 4. HAZARDOUS WASTE 1 <br /> (r,aMin Uad DiO II <br /> Q 95.UNKNOWN <br /> 11).TANK CONSTRUCTION ' <br /> I'YP=CS?.4NK C i. SINGLE WALL 0 3. SINOLB WALLWITHEiXTERIOR ❑5. SINGLE WAIL WITH INTERNAL BLADDER SYSTEM 445. <br /> (Check aaitem on;y) MEMBRANELINER 095. UNKNOWN <br /> 2. DOUBLE WALLd. SINGLE WALL IN A VAULT 99. OTHER <br /> TANX MATERIAL-Piney kmk 1. BAREST <br /> ARE STEEL 3. !'MERG LASS/PLASTIC 05. CONCRETE <br /> 95.UNKNOWN444. <br /> (Ci ko ilcmanly) 02. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS 09. FRPCOMPA'CBLE 099.OTHER: <br /> REINPOS' PLASlC FRP W1109%METHANOL <br /> TANK MATERIAL-rccaad.,tank 01. BARE STEEL f�T3. FTBEROLA531 PLASTIC 09. PRP COMP uILE W/1o0%METHANOL 95.I1NKNDWN 445. <br /> (Clcckoncitcmonly) 02. STAINLESS STEEL Q4. STEEL CLAD W/BIBERGLASS 09. FRPNON-CORRODABLEIACKET 71".OTHER <br /> REFORCED PLASTIC(FRP) Q I0. COATED STEEL <br /> 5. CONCRETE <br /> AN <br /> TK IN1EEOR LA`N'G 1.RUBBER LINED 3.EIN <br /> FOXY LINING Ll 5.GLASS LINING-[195.UNKN WN 446. DATE INSTALLED 4.7. <br /> OR COATING D 2.ALKYD LINING 0 4,PHENOLIC LINING Q 6.UNLINED <br /> Check.ikm onl ❑99.OTHER <br /> OTHERCORAOSION 1.MANUFACI'UAED CATHODIC 3.FIBERGLASS REINFORCED PLASTIC 095.UNKNOWN N& DATE INSTALLED a9. <br /> PROTECTION PROTECTION 0 4.IMPRESSED CURRENT Q 99.OTHER <br /> fA iirabk 2.SACRIFICIAL ANODE <br /> SPILL ANO OVEAPILL YEARINSTAL.LED 45o. TYPE 451. OVERFILLENT: YEAR <br /> .°ROTECTICNEQUIPMINSTALLED 452. <br /> ' (Chcckallthatapply) k[L SPILL CONTALNME?-r Orl.ALARM _al PILL TUBE SHUT OFF VALVE <br /> 3. PLATE <br /> _ <br /> {�2.DROP TUefi X2.BALL FLOAT_ Q4.EXEMPT <br /> �_ ❑ STRIXER <br /> ;V TANKZEWDETEETION °L <br /> Adescri tion <br /> pv6sbillbambjftltted <br /> subrlvded to the iocala'chc <br /> IF SINGLE WALL TANK 451, IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. <br /> (LTm&all rbac apply) <br /> (Ch mkane item ody) <br /> O 1.VISUAL(EXPOSED PORTION ONLY) Q 5.MANUAL TANK GAUGING(MTG) Q L VISUAL <br /> (SINGLE WALL IN VAULT ONLY) <br /> 02..AUTOMATIC TANK GAUGING(ATO) 06.VADOSE ZONE ;N.CONTA'UOUS INTERSTITIAL MONITORING <br /> 0 3.CONTINUOUS ATG Q 7,GROUNDWATER Q 3.MANUAL MONITORING <br /> 04.STADSTICALINVEN\ORYRECONCIUATLON QB.TANK TESTING <br /> (SIR)+BIENNIAL TANK TESTING 099. OTHER <br /> V.TANK CLOSURE.INFORMATION 1.PERMANENT CLOSURE IN PLACE <br /> ESTIMATE D DATE LAST USED(Y O/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 436 TANK FILLED WITH INERTMATERIAL7 457. <br /> pliant [:1 Y. 0 No <br /> UPCF hwfwrc-b(1199).1/4 bttp:#Aw w.uaidoc&org Rev.02/16/00 <br />