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1.2/29/2096 16:06 209468 433 EHD j PAGE 0 <br /> UNIFIED PROGRAM CONSOLIDATED FORM17 ✓/ B�Y/ ( TANR w <br /> UNDERGROUND STORAGE TANKS- c�N P �I FAC X: <br /> (two pages per tnnk) <br /> iYl•E OF ACTION 1 U PPXcl ole <br /> ICAvk only ikm mly) ❑ )NEW SATE➢ERIN)? ❑aAMLR4DEO PEINDT ❑SCMANOE OF NFOKMATIO LJ T MFORARYSRIICLOSURE <br /> 7 FERMAN ENIlY CLOSED ON SITE <br /> ❑J FENEwAlI'ERMII' t � ❑97ANK REMOVED 119 <br /> BUSINESS NADEE(Sm,u FAC'IL:(Y NAMEv DR^.poiy Wsinvt AO FA CTLITY ID: PR X; 1 <br /> C-Pkw�w 2) '1 Ip k- (9 5 2 <br /> L�('IQN WI7FFTrN$ATB(opumN) .l �T . ! tll <br /> p Om <br /> L TANK DESCRIPTION(A staled pla 91m w Ih the loution of Ac UST sy lam Including buddmps BDd landmarks shill be*ubmWeil to the lotsl agency. <br /> TANK IDX 412 TANK MANUFACTLRER ,11 CvI-u AKIMEN I kl-[ n TANK ❑Yee 0 •)• <br /> /� /� IPYn".<omPlav o,PnFfv<vAmmpWPnml, <br /> DWl <br /> A ENST D(YEAR/MOJ GI IA.JY IN NUO <br /> R PTUMPARTMENTS ,17 <br /> ADDITIONAL DESCRIPTION liar local uv onp7 1I9 <br /> LI,TANK C NTT:NTS <br /> _ USE 139PEIIiOLeUM TYPe „a <br /> M070RVEHICLE FVPL ❑ IP.REGULAR UNLEADED ❑ 2,LEADED ❑ 5JET FUEL <br /> ppn4rtwmmpmv im.e.m T.yel ❑ 1EpKfimlUM 11NLBADED Rof,IJESFL ❑d.AVIATION KIEL <br /> ❑ 2 NON-FVEL1'ETKOLEUM ❑ le.MIDGRADE UNLEADED ❑ d, ASOHOL ❑99.OTHER <br /> ❑ I.CHEMICAL PRODUCT COMMON NAMED,,.xv.c,«MwHw lmxwu ) •.•.uyp g ) 4q <br /> ❑ 4 HA2AkDOUS WASTE OFF 4,1 GSX Ifrn Ho:+Nwx Mmaa+Yl• ac <br /> Pmhily lh440.0 <br /> ❑ P5 UNKNOWN <br /> / m.TANK CONSTRUCTION <br /> TYPE OF TANK M -SINGLE WALL ❑.l SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 441 <br /> leases e.km w4y, EXTERIOR MEMBRANE ENER ❑95.UNKNOWN <br /> ❑ 2.DO BLE WALL ❑4.SINGLE WALL N VAU T ❑9P.OTHER <br /> TANK MATERIAL.pn.m .oN, 1.DARE STEEL ❑FIBERGLASS I PLA57C ❑5.CONCRETE ❑95.UNKNOWN N4 <br /> ICN Lm,4m,Nr) ❑2.STANLESS STEEL ❑STEEL CLAD WNIBE tOLASS ❑K FRP COMPTIBLE W/1001/6 METHANOL <br /> REINFORCED➢LAST C(ETU') ❑ 99 OTHER <br /> TANKMATEIUAL-second yunR IqAA&SlEzL ❑e.FIBERGLAS /PLASTIC ❑S.CONCRETE ❑ 95.UNKNOWN u) <br /> Meme«e Se.acyl .STAINLESS STEEL ❑ a.STEELC WFFIBEROLMS ❑ x.FKFCOMPTSLEW/100%METHANOL <br /> REINFORCED I LASTIC(FAF) ❑ MCOATEDSTEEL ❑ M.OTHER <br /> ❑5.CONCRETE <br /> TANK NTENOR LINING ❑ I.RUBBERLNED ❑ I.EPDXY LINING ❑ S.GLASS LINING ❑95.UNKNOWN "4 DATEMSTALLED 4tl <br /> OR COATING ❑99.OTHER <br /> (Ok6 ea'.w•4y) ❑'_ALKYD LINING ❑APHENOLIC LINN UONUNED liar lvY uumly) <br /> OTHER CORROSION ❑ 1 MANUH\CTURNGCATHODIC 0.1 FiBERGL SS RBINMIUMD PLASTIC 95UNKNOWN tae DATE INSTALLED •419 <br /> PROTECTION IF APPLICABLE I'R07ECTION <br /> (Club are ilm,•Nf ❑41MPFSSSIOCURRENT' 099 DTIER <br /> ❑3 SACRIFICIAL ANODE IFv bay nn«y) <br /> SPIV AND OVERFT YEARINSTALLE4I0 rfpelllI) 61 OVERFILL PROTC N EQUIPMENT,YEAR INSTALLED Alf <br /> (C), a SIhaI <br /> KST�,LLIP, <br /> CONTAINMENT <br /> IAWUN ❑ 1TLL TUBE SHUT Off NAL` <br /> TUBESxpl <br /> PLATE 0 C3❑ 'BALL ❑ cFJ(EMn'T <br /> FLOAT' <br /> IV.TANK LLAKDETE ON(A de,ViOtIa,.1 W4 n4nuvdna wep,•n dNIM nNSnmuJelx,l qex):) <br /> IF SINGLE WALL TANK(QW A IM+m•b) ki 45) IF DOUBLE WALLTANK OR TAM:WI IBLAODEK U4 <br /> ❑ I VISUAL(EXPOSED PORTION ONL I SM TANK OAUG.0(MTO) lCanE•Mimmod.7 <br /> ❑ IAUTOMA7ICTANKG UOINO T VADOSE LONE ❑ I VISVAL(SNCLEWALLINVAVL ON <br /> ❑ )CONTINUOUS G ❑ 7GROUNDWATER ❑2 CONTINUOUS INTEESTIT MO ITl !1 <br /> ❑4S'TATISTICAL NT00. NCiLIA ❑ STANK TESTING C3;MANUAL MONITOION I1Ly� \ <br /> (SIR)BIENNIAL TA T 0 ❑990THER <br /> v.TANK CIAS[TQE INFORMATION PERMIAN LNIf CI,OSURE IN PUCE <br /> MTIIAATED DATE WT USED(YkNO,DAY) 45I ESTIMATEDQUANTRYOF. 'BSTANCEREMMNING q9 TANK FILLEDw'ITHNERTMATBRin 07 <br /> ❑Yee <br /> UPCr 112111 rcvl,cd) <br />