BILLING 2007 - 2013 - Laserfiche WebLink

Home Browse Search

001196 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK (! I OPERATING PERMIT APPLICATION-TANK INFORMATION (one formperus) TYPE OF ACTION (Check one i(em only. Fora UST ctostme or removal complete only dds section and Secttom I.A BI.IF and lWbelow) 4". 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 0 7 UST PERMANENT CLOSURE ON SITE 0 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430" I DATE EXISTING UST DISCOVERED: 4506 I. FACILITY INFORMATION FACILITY 1D p(Agency Use Only) - - 1' T-F BUSINESS NAME(Samas Facility Name a DBA-Doinglimit cfs As) 3. I B S S ADDRESS in CITY , 104 IL TANK DESCRIPTION TANK D# 432. 1 TANKMANUFACTURER �ANK CONFIGURATION:THIS TANK IS 4J0. ©2 /lO� O / < 4J3. I.A STAND-ALONE TANK Complmeoro"(Re 2.ONEINA COMPARTMEN EDUNIT -Tsa tlafte . DATE UST SYSTEM INSTALLED435 TANK CAPACITY IN GALLONS 436 1 NUMBS OF COMPARTMENTS IN THE UNIT 437. III. TANK USE AND CONTENTS TANK USE Ie.MOTOR VEHICLE FUELING 0 In MARINA FUELING 0 Ic.AVIATION FUELING 49. 3.CHEMICAL PRODUCT STORAGE 0 4.HAZARDOUS WASTE(ImJW.I OR) 0 S.EMERGENCY GENERATOR FUEL DISC I2S2815411 0 6.OTHER GENERATOR FUEL 0 95.UNKNOWN 0 99.OTHER(E ): 439a CONTENTS PETROLEUM. 'a[-:] Ic RHOU0 Ic.MIDGRADE UNLEADED 0 I6.PREMIUM UNLEADED 440. 3.DIESELLAR UNLEADED 0 5.JET FUEL 0 6.AVIATION GAS O S.PETROLEUMBLEND FUEL 09 OMER PETROLEUM(Specffy): 91_ NON-PEIROLEUM.O 7.USEDOIL 0 METHANOL ❑ 11.OTHER NON-PETROLEUM(S 4406. IV. TANK CONSTRUCTION TYPEOFTANK I.SNOLE WALL z.DOUBLE WALL Q 95.UNKNOWN 443. PRIMARY CONTAINMENT' (] 1.STEE. 3.FIBERGLASS 0 6.INTERNAL BLADDER 441' ❑7.5'IEE.+ LINING 0 95.UNKNOWN 0 99.OTRER(Spacify): 444a SECONDARY CONTAINMENT 01.STEEL 3.FIBERGLASS 0 6.EXTERIOR MEMBRANE LINER 0 7 JACKETED 445. ❑go.NONE 95.UNKNOWN 099.OTHER S .445n OVERFILL PREVENTION OI.AUDIBLE ALARMS 02.BALL FLOAT 7.PILL TUBb SHUT-OFF VALVE 432 4.TANKMEET3 RE UIREMENTS FOR EXRMPTION FROM OV i PREVENTIONE UIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPINGCONSTRUCTION 01.SINGLE WALL 2.DOUBLE WALL Q 99.OTHER 460 SYSTEM TYPEI.PRE93URE 2.GRAVITY 03.CONVENTIONAL SUCTION 04.SAFE SUCTION CIX 3 45R PRIMARY CONTAINMENTI.STEEL /�.�]� FIBEROT ASS 0 8.FLEMBLE 0 IO.RIGMPLASTIC 464. _❑ 90.NONE L'J Y5.UNKNOWN 0 99.OTHER } 464` SECONDARY CONTAINMENT 0 LSTEEL 4, FIBERGLASS 0 &FLEXIBLE 0 10.RIGIDPLASTIC 4646 0 W.NONE 95 UNKNOWN 0 99 OTHER(Spft*): 464a PIPlNQ7URBTNE CONTAINMENT SUMP TYPE 1.SINGLE WALL 0 2.DOUBLE WALL U 90.NONE 1646 VL VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1 STEEL 4.FIBERC[ASS ❑ 10.RIOID PLASTIC ❑ 90.NONE 099.OTHER(Spetlfy): 4641. VENT SECONDARYCONTAINME4NT 01 STEEL 04.FIBERGLASS 010.RIGID PLASTIC .NONE 0 99.OTHER(SP=fY): 464n. VR PRIMARY CONTAINMENT ,(I.STEEL 0 4.FIBERGLASS 0 l0.RIGID PLASTIC 0 90.NONE 0 99.OTHER(SP=fy): q VR SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS 0 l0.RIGID PLASTIC _Qr9nNONE ❑99.OTHHR(Spedry): 4 alight. VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL [12.DOUBLE WALL 90.NONE RISER PRIMARY CONTAINMENT 1V'1.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(SpecilY): _��' _ alio'. RISER SECONDARY CONTAINMENT f.STEEL 4.FIBERGLASS 0 I0.RIGID PLASTIC 0 90.NONE 0 99.OTH8R(Sperm): 46461. FILL COMPONENTS INSTALLED 141.SPILL UC .STRIKER PLATHIBOTTOM PROTECTOR 4.CONTAINMENT SUMP VU UNDER DISPENSER CONTAINMENT(Urie) CONSTRUCTION TYPE 7.SINGLE WALL 0 2.DOUBLE WALL 0 3 NO DISPENSERS 0 90.NONE 469a CONSTRUCTION MATERIAL I.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC 0 99.OTHER(Specify) 4gJc % VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION 0 2.SACRIFICIAL ANODES) 0 4.IMPRESSED CURRENT 6.ISOLATION 4/& LY. APPLICANT SIGNATURE CERTIFICATION:I eeAify that this UST system U campatible with the hmardous substance stored and that the information provided herein 1,true, necurste,and in full mm fiance with atairemenb. APPLICANT SIGNATURE`_.. DATE 6 4'N' APPLICANT NAME(print) t 471' APPLICANT UPCF UST-B Rev.(1212007) 12 www.vuahlacz.org 1�