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12/29/2006 16:06 209466 433 EHD �7 <br /> U'7 12,1,1 <br /> UNIFIED PROGRAM CONSOLIDATED (1'9/P/ <br /> FORM y1 <br /> TANK: <br /> /Q <br /> UNDERGROUND STORA E TAN - PANG 1 ( ( PAca: <br /> 2–{ U ? �[V� (SY.V pap,par Ionic) <br /> TYPEOFACTION 1�� tap<2 ofJ <br /> In�vi mplu.,e.y) ❑ INEw SITEPRILMIT ❑AAMENDED PPAMIi ❑ JCH,WGE OF INFOKM,A'fbN ` ❑6'! Ml'ORMYSITE CLOSURE <br /> p.� 9 PERMANFINTLY CLOSED ON SITE <br /> El RENEWAL PERMIT '.e 19 1' . ❑STANK REMOVED 110 <br /> BVSUpE55 NAML•(5.mev PACWTYNANLe.11PA- A,) F LTLTTYrD;I PR a: B 1 <br /> i 2 e4 <br /> LOtATION WITHIN SITE <br /> (Opm.o) 7 / all <br /> 2 1 — , ' M S iL PHONE <br /> 1.TANK DESCRIPTION(A scaled plot plan with the lowtioo of the UST sy loan including buildings and landmarks shall be submlaed to thr local Agar,F.) <br /> TANK IDS2 / _ J.1 A �ACTUER �. A .A. . A C]Y" o 44 <br /> lip ' IPYu-,,unplacca.p.pfv•vhmnpvuvns <br /> DATE INSTALLEO(YEAWMO) A55 TANK CAP d9sNUMBER 07laAATIaNTT- <br /> 5)1 <br /> DD <br /> ADDITIONAL DESCR�TION par Ioulm<auyl JP0 <br /> IT.TANK C ONTENTS <br /> K USE up P+I" TYPE Na <br /> LMOTOR VEHICLE FUEL AR UNLEADED FADED ❑ 5.JET FUEL <br /> Dr.w.a.a,pyv huNwm T)op) ❑ Ib.PREMIUM UNLEADED ❑ ).I-TESEL ❑ 6.AVIATION FUEL <br /> ❑2.NON•FUGL PETROLEUM ❑ Ic,MIDCRADC UNLEADED ❑d.1,ASOHOL ❑99.OTHER <br /> ❑ I.CHEMICALPRODUCT COMMON NAME(fcoka.dru MrnviUalme.pry q .sl cAEa lhmp Xpasdpa MRpdpk A.umH PaEe) .,I <br /> ❑ d.HAZARDOUS WASTE <br /> IM.IuL.t1wJ Off) <br /> ❑ 95.UNKNOWN <br /> IILTANKCO "STRUCTION <br /> TYPE Of TANK I.SINGUINALL ❑ L SINOLEWALL WITH ❑ S.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 1.2 <br /> ICsup..,no.WS) EXTERIOR MRMDMN¢I MER ❑ 93.UNKNOWN <br /> ❑2.DOUR WALL ❑d.SINOLEWALL M VAULT ❑ 99.OTHER <br /> TANKMATERIAL-prlmvyurJi I.EARE STEEL ❑11BEROLASS/fLASTC ❑5.CONCRETE ❑05.UNKNOWN <br /> (h,11 p••'�'m dJd ❑1.STAINLESS STEEL ❑STEEL CLAD W/PIBE OLASS ❑S.FRP COM71MLE W/IODA METHANOL <br /> � <br /> aa REINFORCED PLASTI (FRP) C]w.OTHER <br /> TANK MATERIAL"pamd.ry renktJ ,BAR.ESTEEL E]2.FIB¢RGLASR I PLASTIC ❑S.CONCRBTE 09S.UNKNOWN NS <br /> (hark o,ailanoWl I�❑^_.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ F.FRP COMPTIBLE W/I901A ME'fHANDI, <br /> REINFORCED MASTIC(FM) ❑ IBCOATEDSTEEL ❑ 99 OTHER <br /> ❑5.CONCRETE <br /> TANK INTERIOR LNING El 1.RUBOER LINED ❑ 1.EPDXY LINNO ❑5.G WING 095.UNKNOWN Ild DATEINSTALLED ..a <br /> OR COATING <br /> ichaltalima Jy) 2ALKYD LINING (PHENOLIC LININ LINED (3 99.GT{I¢R <br /> ❑ ❑ (ru leu w.aJy) <br /> OTIMR CORROSION ❑ I MANUFACTURTNOCATHODIC ❑1 FlBERGL SS REINFORCED PLASTIC UNKNOWN .Np D.ATEINSTALLED ..p <br /> PROTECTION IF APPLICABLE PROTECTION URO`RESp DCUKRENT ❑990TH¢R <br /> frMka.it.WO ❑ 2 SACRIFICIAL ANODE (ra laum.alyl <br /> SPILL AND OVERFILL YEAR NSTALLE450 TYPS(.I..a y1 151 OVEAFH.L PROTTCTON EQUIPMENT.YEAR N'STALLED or <br /> fU ,,u WPly) ❑ I SPILL COWTAINMFNT Q (ALARM ❑IFlLLTVBQSHUTOJTVAL' <br /> ❑ 2DROPTUOE ❑2RALL ❑,EKEMPT <br /> ❑ (STRIKER PLATE 4a I FLOAT <br /> N,TANK LEAK DETECTION N do.Wim.1 W lmhud lcmflwl.a..nJ <br /> V SINGLE WALL TANK(hmkal paupPly) .51 11 DOUBLE WALL TANK OR TANK WITH BLADDER .5. <br /> ❑ I VISUAL(EWOSED PORTION ONLY) ❑S MANUAL TANK GADO ,(MTG) jC1f1i OAenN°Jy) <br /> ❑ 2AUTOMATIC TANK GAUGING(ATC) DEVADOSCZONE ❑ IVISUAL(SINOLEWALL IN VAULT ONLY) <br /> ❑ 3CONTMMS ATG ❑TOROUNDWATEK ❑ 2CONTN000SNTERRITIALMONRORWG <br /> ❑ p STATISTICAL INVENTORY RECONCIL T10 ❑STANK TESTING ❑J MANUALMONITOIUNG <br /> (511)BIENNIAL TANK TESTING ❑99 OTHER <br /> V.TANK CLOSURE TNPORNATION PERMANENT CLOSURE W PLACE <br /> ESTNLITEDDATELASTUSED(YIVMOJDAY) .55 ESTIMATED QUANTITY OF S JESTANC9 REMAINING .54 TANK PILLED WITH INERT MATERIAL? e51 <br /> ❑Y., ❑NP <br /> UPCF(12/99 rriscd) <br />