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SAWT04 Qu to COUNTY UNIFIED PROGRAM CONSORTED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> c�wenra� <br /> TYPEOFACDON ❑ LNEwpEnaL ❑4A!13IDIDPOMW frA�S.CHANGEOFNWRMATON ❑ 6.TOOOKARYTANKCEOSURE 4M <br /> (Outmip®dlq ❑3.RENEWALPERLff -I- <br /> .- ❑7.PFRMANINN'1LYQASEDONSPIE <br /> 4�) {SP.rIfTaW ❑ RTANKREMOVED <br /> BUSINESS NAM(S...FAcfflfYNAm@ nm-DiotllabaM) 3. FACBSTY If7. <z±�;t <br /> 1. <br /> LOCATION WITHN SITE(9pd. ) al. <br /> L TANKDESCREMON <br /> (Axakd wilhlLelo4mYtim olPoe USt sy>liar)n�s>Aaa�pamalmll�da>�L.RIe>�i1�d_mt)rbnl,ge,ey) . .:, .., <br /> TANK ID# 4a TANK.MANUFACTURER to COMPAKTNWFFAE�TANK Yes NO 414 <br /> rrYa'�tmcnaotaQsm�. <br /> DATE INSTALLED 43S TANK CAPACTTYIN GALLONS o6 NUMBER OFCOIOPA*-TMMM <br /> (YPAR/MO) 437. <br /> ADDITIONALDESCRIPTONT.6w.amg3 Ge <br /> R.TAW CON1ENTS <br /> TANK USE 4" PETROLEUM TYPE <br /> 4a <br /> Q L MDTORVEHrIE FUEL Ell..R$OIARTNLEADED ❑7 LEADED 05.XrFUEL <br /> (W`b=imd'O°"I ` T® W 0I PRBffLJMUNLEADED 03.DBSSEL 136.AVIA110NGAS <br /> ❑ 2 NON-FUEL.m7RO Eumlc MR)GRADEuNLEADLD <br /> ❑ ❑4.OACM1HlY 09➢.O'I1ffR <br /> ❑ 3. CHDAWAL PRODUCT COMMONNAM3(6®131odm9YvuYU..etrFp�e) MI. CAS#l6mA�eoml,4biWl^.mM3ts1 az <br /> ❑ 4. HAZARDOUSWASTE <br /> (hdW.Dsd N) <br /> ❑ 95.UNKNOWN <br /> ID.TANK CONSTRUCTION <br /> TYPEOFTANK 0 L SDRAE9/ALI. 03.SQRIIEwALLWTD1EKf XfOk 5.SINGIEwALLWTRNIERNALBLADDERt- <br /> W/10% <br /> 4e3. <br /> (cbwkr i cnly) MEMBRANE LINER 1395.UNKNOWN <br /> 2 DOUBLEWALL 4 SRR"WALL INAVAULT 99.OTHER <br /> TANKMATOUAL-3 ,� L BARE SEEM 3.F111EX if• S/PLASTIC 5.CONCRETE 95.lINKFAWN4a. <br /> (oe3mum sy9 ❑7 9EADUMsmM ❑t SUMCLADW/FUERC ASS 13L FRPCOMPATIDIE ❑99.OTIDR: <br /> 7ANKMATDUAL- PFJNlDRCIDPIASIIC WA003LMEIHMIOL <br /> xcmdNytdc ❑1.BARESIEQ. 3.Flnavnr 4S/A.ASIICMEIHANOL ❑95.UNKNOWN uS <br /> (C4xkm. only) ❑7 S AINLMSIF}I..134 STEELCLADW/FFMERGLAM 09_FRPNRJI] RRODABIElACKU ❑99.071FR <br /> REDIFO ®PfASTIC(FRP) 1310-COATEDsfm. <br /> 5.OON RELE <br /> TANKNLENORLNRIG E3 LRUBBFRLDIED 3.EPDXYLENNG 5_GLASS LINING ❑9S.UNKNOwN 44A DATEDWALLED 449. <br /> ORCOATING ❑2ALCYDLDIDO ❑4.PHENOLCIDNIO ❑6.UNLD= ❑99.OTHER <br /> CBxk-U® <br /> OTLIDLCW<OQON LMANOFACRIRHDCATiOW 133,FfRPYCd eccRffiLFORLFD PIASTO 9S.UNgOWN 44a DATE INSTALLED <br /> M9. <br /> PROTECTION I80'tECDON ❑4BIPRESSFDCURRENf ❑99.OTFhR <br /> a 25ACRQ'BLTAL,ANDI)E <br /> SPIII,AND @ . 1TfED ua TYFE 45L OVFRFHJ.AUf®CTION <br /> (C73xk.R lhtapply) X DRO.CUNTwD1I4NC ?.�F�\ ❑1 ALARM L❑3�3.FUL M:BESIFTORFFFVALVE <br /> 3.STRIKER PLATE ❑ RAL FLQAT_❑4.EXDAPC <br /> IV.TANI bE1TAM0N <br /> IF SINGLE WALLTANK 13fPoe "Ul�solmiRM to me kW mgmwy.) <br /> 21'DOUBLE WALL TANK OR TANK WITH BLADBBR - tx <br /> ((]xl4 au 0u dP*)" (Chwkm i Q*) <br /> ❑1. <br /> VISUAL(EXPOSED PORTON ONLY) El 5-MANUAL TANKGANRNO Qau) El VISUAL. <br /> (SDRiIE WALL IN VAULT ONLY) <br /> ❑1'AUIOMAHCTANK GAUGING(ATG) ❑6.VADOSEHNE ❑i CONTHfUOLSRNTPRSr IIAL MOMORING <br /> ,.❑3.CONTUMUS ATG 137.GROUNUWATFB ❑3.MANUAL MONC[ORNG <br /> ❑4.STATWhCALNVFNTORYRBCOMIIIATMN ❑LTANKTESDNO <br /> (SM)+>ffiWALTANKTEMM 13 99L Oran <br /> V. CLOSUR=Akms:k- <br /> TANKIERMANENTCLOSUREINPWXFSUMATEDDATEIASTUSM77M tu. srwNMRFaIADmac t56 iwFS WIIHI�U7'111AIPYLIL+Ye ❑ No <br /> 61 <br />