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4 Oct 23 06 12: 12p owner 209-941 -0142 p. 2 <br /> • �,P,N �b <br /> A <br /> p-dB(p <br /> UNIFIED PROGRAM CONSOLIDATED FORM PI <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (Two pages pertank` <br /> Page_of_ <br /> TYPEOFACTION 0 1.NEW PERMIT 0 4-.k ENDED PERMIT 0 5.CHANGE OF INFORMATION 0 6.TEMPORARY'T.INKCLOSURE 430. <br /> (Chat on<immonly) kf 3.RENEWAL PERMIT 0 7.PERMANENTLY CLOSED ON SITE <br /> (Spaifymasan) (8paily sawn) 0 8.TANK REMOVED <br /> s, 1Tt. <br /> BUSINESS NAME(sswePAaLtiY NAME o.nnA-pang B,unes M) 17ACILY 0: _ <br /> Wc�a7 t_oa+c Ck�aror+ <br /> LOCATION WITHIN SITE(Opion.N 4.,. <br /> q T�'17 G�-4+T 4-Nn�c r SrCp bk ra„ <br /> 1.TANK DESCRIPTION.: <br /> A scaled plot elm with thcloaa6Woftbe UST.systemmcludtu bui end tsndmazks shall be submitted to the locale <br /> TANK ID#5 43z TANKMANUFACTURER 4n' COMPARTMENTALI7ED TANK Yes No 434, <br /> �'L�2�� 1C'Yer."canPkteorcpA•P kr evhwmpartmem. <br /> DATE INSTALLED 433. TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> (YEARIMO) I$r a0 <br /> ADD TfIDNAL DESCRIPTION(Fa kcn1.-V) 439. <br /> IL TANK CONTENTS <br /> TANK USE 439, PETROLEUM TYPE <br /> I. MOTOR VEHICLE FUEL Cl 1a. REGULAR UNLEADED 0 2. LEADED 0 5. JET FUEL <br /> (IfclxekM.<ompinc Pcmokvm Typc4 <br /> [I 1b.PREMIUM UNLEADED pr3. DIESEL ❑6. AVIATION GAS <br /> ❑ 2. NON-FUEL PETROLEUM 0 la MIDGRAUE UNLEADED [14. GASOHOL ❑99.OTHER:_- <br /> ❑ 3. CHEMICAL PRODUCT COMMON NAME• (Oos HammushWaiaCSwworyp4ge) 941' CASY fawnBmN4ua Meiaiah fwv4ivy wac) 'N2 <br /> ❑ 4. HAZARDOUS WASTE <br /> (1.1WuUsed0l) <br /> ❑ 95.UNKNOWN <br /> III.TANK CONSTRUCTION : <br /> TYPE OF TANK ❑I. SINGLE W ALL ❑3. SINGLE WALL WITH EXTERIOR ❑S. SINGLE WALL WITH LNTEANAL BLADDER SYSTEM 443 <br /> (Checkoncit ..Iy) MEMBRANE LINER 095. UNKNOWN <br /> 2. DOUBLE WALL 4. SINGLE WALL IN A VAULT 0 99. OTHER <br /> TANK MATERIAL-P-mnvenk 1. BARE STEEL 3. HBERGLASS/PLASTIC 05. CONCRETE 095.UNKNOWN 444. <br /> (Chat oM eanany) 02. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS 08. FRP COMPATIBLE 099.OTHER: <br /> REINFORCED PLASTIC FRP W/100%METHAN0L <br /> TANK MATERIAL-secondary hok 01. BARE STEEL 3. FIBERGLASS/PLASTIC S. FRP COMPTIBI.L•, 100%METHANOL 095.UNKNOWN as. <br /> (Check one item only) ❑2. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS 09. FRP NONCORRODABLE JACKET 099.OTHER <br /> REINFORCED PLASTIC(FRP) [110. COATED STEEL <br /> ❑5. CONCRETE <br /> TANTOINTERIORLINING 1.RUBBERLINED 0:i EPDXYLMING 05.GLASSLINING 095.UNKNOWN 446. DATE INSTALLED 447. <br /> ORCOATG 02.ALKYD LINING 04.PRENOLICLINING 06-UNLINED ❑99.OTHER <br /> IN <br /> Check one <br /> Net <br /> PROTECIONOSION ❑I.MA:NUFACILRED CATHODIC 03.IMPRESSEDEURRENRCEDPLASTIC 095.UNKNOWN 446. DATE INSTALLED 449. <br /> PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER <br /> If A licabk <br /> [12.SACRIFICIAL ANODE <br /> SP)LL ANO OVERFILL YEAR MSTALLED 450. TYPE asl. OVERFILL PROTECRONTj31pMENT: YEAR INSTALLED a52. <br /> (Check all chat apply) ®].SPILL CONTAINMENT ®.i.ALARM -6I3.FII,LTUBE SHUT OFF VALVE__ <br /> 2.DROP <br /> TUBE W2.BALL FLOAT-_0 C EXEMPT <br /> 3.$IRJKER PLATE <br /> IV.TANK LEAK DETECTION , <br /> (A descripdonofthe matitorin ahellbe submitted to The totals cy. <br /> IF SINGLE WALL TANK 453. IP DOUBLE WALL TANK OR TANK WITH BLADDER 454. <br /> (Check a1 dmtapply) (Check one itemcoly) <br /> I.VISUAI-(EXPOSED PORTIONONLY) 05.MkXUALTANKGAUGING(MTG) 01.VISUAL(SINGLE WALL IN VAULT ONLY.) <br /> ❑2.AUTOMATIC TANK GAUGING(ATG) 06.VADOSE ZONE X2.CONTINUOUS INTERSTHYAL MONITORING <br /> ❑3.CONDNUOUSATG 07.GROUNDWATER 03.MANUAL MONITORING <br /> 04. STATISTICAL INVENTORY RECONCILIATION 0 8.LANK TESTING <br /> (SIR)+BIENNIAL TANK TESTING 099.OTHER <br /> V.TANK CLOSURE INFORMATION 1.PERMANENT CLOSURE IN.PLACE <br /> ESTIMATED DATE HAST USED(YR/hIONAY) 435ESTIMATEDQUAIMTYOFSUBSTANCEREh(AINNG 456, TANK FILLED WITH INERT MATERIAL? 457' <br /> SAM 0 Yea 0 No <br /> UPCF hwfwre-b(1/99)-1/4 http://www.onidumarg Rev.02116/0/ <br />