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Ic0 PROGRAM CONSOLIOATEO FO <br />UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br />TANKS <br />MOp soB/rank) <br />rypE OF ACTION Q 1, NEW SITE PERMIT Q A. AMENDED PERMIT ❑ 5. CHANGE OF TNFCRMATICNI Q 5, TEMPORARY SITE CLOSURE <br />!Check ons rtam muYl Q T. PERMANENTLY CLOSED ON SITE Q <br />I—II RENEWAL PERMIT ..... Inr rval �.ie nNvl !$paOlY flMn9i-51/Ii31 Yxi UnMi d. TANKREMOVEO +30 <br />BUSINESS NAME(Same as FACILITY •NAME ar DBA. Com98a era Axl FACNTYID <br />LOCATION WITHIN SITE IDPbonal) tlT <br />mo E WtTWO�L <br />I. TANK DESCRIPTION <br />TANK 10 TANKMANUFACTURER <br />CDMPARIMENTAUZED TANK <br />�2 V�� <br />II"!b'.Emblem mi pa9a MeaNl ammrvnertt. <br />C'^ <br />I�J Vow <br />DATE INSTALLED (YELARIMO) TANK CAPACITY IN GALLONS <br />NUMBER OF COMPARTMENTS <br />mL Iv Ooa <br />AOOITIONAL DESCRIPTION (PW MPI Vaa PI9Y) <br />IL TANK CONTENTS <br />+ <br />PETROLEUM TYPE <br />Q 2 L.EAOEO <br />Q i ;E'FUELhro <br />VEHICLE FUEL <br />TYpel <br />is REGULAR UNLEADED <br />❑ <br />d. AVIATION FUEL <br />Pe11UMbalf <br />Q 15 PREMIUM UNLEADED 1 DIESEL <br />=USE�NKUSE <br />ELPETROLEUM <br />Q Ic MIOGRAOEUNLEADED Q °- GASOHOLW <br />OTIIER <br />AL PRODUCT <br />COMMON NOUS <br />WAST 0nPPPP') <br />!11. TANK CONSTRUCTION <br />TYPEOFTANK I. -SINGLE WALL Q 1'SINGLEWALL MTH <br />Q S. SINGLEWALL'MTHINTERNALBIAWERSYSTiEM <br />E)RERICR MEMBRANE LINER <br />Q <br />Q 95. UNKNOVM <br />(CM wam rtam pnry) Z. OOUBLE'MIALL Q +. SINGLE'NALL iN A VAULT <br />❑ 99. DTHER <br />TANK MATERIAL Pnmery mm Q I BARE STEEL Q 1 FIBERGLASS I PLASTIC <br />Q 5. CONCRETE 95. UNKNOWN <br />(CMCN whflem pnryl ❑ 2. STAINLESS MEL 7 a. <br />Q 3. FRPCOMPATIBLE'M100%MEHANOL Q9B. OTNER <br />REINFORCEDA�WERGLAS <br />TANK:AATERIAL sefLntliry mm Q I. 9PRE STEEL L ]. leeRaLxss i PLASTIC <br />Q d FRPCCIMPATIBLEmw%METHANOL 95. UNKNOWN <br />(O/le'Pk one Prem amyl Q 2 STAINLESS 5 c1 Q 4. <br />Q 9. =RP NCNCORRODIBLE JACKS Q 99. OTHER <br />REINFORCED PLASi1C'FRP7 <br />❑ 10. COATED STEEL <br />Q 5. cQNCRETE <br />TANK INTER100. LINING Q 1 RUBBER LINED G 3. Epl]XY LINING <br />DATE iNSTALlEO <br />❑ S. GLASS LINING .195. UNKND'NNK]] <br />OR COATING <br />❑ L ALKYD LINING Q i. PHENOLIC LINING <br />Q d. UNLINED Cl W. OTHER /FPrl0ol u9a PRNI <br />(CALCI one Kam Pray/ <br />DATE INSTALLED <br />OTHER CORROSION Q L MANUFAG•.IJREDCATHO01C Q 3. FIBERGLASS REINFORCED PLASTIC 95. UNKNC%M +�° <br />PROTECTION IF APPLICABLE PROTECTON ❑ s. IMPRESSED CURRENT <br />❑99. OTHER lFPrlNlupgeyf <br />(CMrJr mh from Pray) Q 2. SACRIFICLALANOOE <br />YEAR INSTALLED (FarbNmmal9 <br />OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED <br />(TYPE <br />SPILLANOOVERFILL <br />(CbedradroafapPS'I Q 1. $PILLOONTAINMENT <br />Cl 1. ALARM Cl 3. FILL TUBE SHUT OFF VALVE <br />Q L CROP TUBE <br />Q L BALL FLOAT Cl °. EKEMPT <br />Q 3. STRIKER PLATE <br />IV. TANK LEAK DETECTION <br />I <br />IF WUBIE WALL :AHK OR TANK COITAL BUDDER (CMar Pm fNmanM' <br />IF SINGLE WALL TANK (ClIePk aY mel appryl: I <br />Cl I. VISUAL(E POSEDPORTION ONLY) <br />Cl 5. MANUAL TANK GAUGING iMTGI <br />❑ 1. VISUALISING VMLL IN VAULT ONLY) <br />Cl 2. AUTOMATIC TANK GAUGING (ATG) <br />Q e. VADOSEZONE <br />Q L CONTINUOUSINTERSTIIIALMONITORING <br />Q ]. CONTINUOUSATG <br />Q T. GROUNDWATER <br />Q 1 MANUALMONTORING <br />❑ 9. STATISTICAL INVENTORY RECONCIWTION(SIRI- <br />Q S. TANKTFSTING <br />31ENNIALTANKTESTNIG <br />Q99 OTHER <br />V. TANK CLOSURE INFORMATION/ PERMANENT CLOSURE <br />IN PLACE <br />ESTIMATED DATE LAST USED IYRIMOIOAY) ESRMATEO OUANTI7Y OF SUBSTANCE REMAINING <br />aT5 TANK FlLLED WITH INERT wTERmI'/ <br />3MIPn9 <br />Q Yea Q Ne <br />CUPAFORM (4/99) - • <br />ja,-I�-S '° 71 <br />Fold <br />SNRCP B <br />