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a+ ' Ur D PROGRAM COON OLIDATED FOID j0e? �wm <br /> TANKS -TANK PAGE 1 ? -5-m <br /> LTDERGROUND STORAGE TANKS �(T�pay tank) <br /> page_of_, <br /> 5.CHANGE OF INFOR.KATION ❑ 6.TEMPORARY TANK CLOSURE 430_ <br /> TYPE OF ACTION <br /> -EW PELMTT ❑ 4.AVfENUED PL-RM17 ❑ ❑ 7.PERMANENTLY CLOSED ON SITE <br /> ❑ 3.RE`IEWAL PERMIT �- �) ❑ 8.TANK REMOVED <br /> (C1'aek (specify <br /> BUS S NAME ISM-FACLM?4A- 'ORk-D*7 � ) 3. FACILITY ID: <br /> LOCAno-W TfE1IN I0 <br /> ( oom+0/O c✓�L <br /> SO L TANK DESCRIPTION <br /> ' (A scaled plot plant with the location of the UST sysrcm incltulin buildmgs and�laadrtrarlaCOMPAARRTMsENTAL tted toD TANNKK agmc <br /> Ya) No asn. <br /> 431 I TANKM ACTURF.R <br /> TANK IDS (��%% If,-eavvtav asPcec f,xnm�mm�m <br /> / , <br /> _.,' � IN GALLONS AM. I N UMBER OF COMPARTMENTS 437. <br /> DATE INSTALLED 43s. TANK CAPACITY <br /> (YFAR/M1IO) ! n/! 5"Q D 438. <br /> ADDITIONAL DESCRIPTION(For Imp use°nh) <br /> II.TANK CONTENTS ,ro. <br /> TANK USE 439. PETROLEUM TYPE <br /> SLEI FUEL <br /> j] 1. MOTOR VEHICLE FUEL ❑Ia REGULAR UNLEADED ❑2' LEADED ❑6. AVIATION GAS <br /> Bfntxba®cMeP�°k10"7)Pcl ❑lb. PREMIUM UNLEADED 3. DIESEL C3 /�!99.OTHER' i eC �5r e <br /> m2 <br /> [3 2 NON-FUEL PETROLEL?f ❑lc. MIDGRADE LI'IFADED 4. GASOHOL❑ Hyl_ C�r(6� a��s lnvmmry pn6<) <br /> ❑ 3. CiUMICAL PRODUCT COMMON NAME (e.Haatdma M••^•�°(°sCA1O`y Page) <br /> ❑ <br /> A. HAZARDOUS WASTE <br /> (Ivcaales Usd Oip <br /> 5.UNKNOtVN <br /> III.TANK CONSTRUCTION u3 <br /> INGLE WALL �. SINGLE WALLWRH EXTERIOR 5. SLNGiEWALL WITH INTERNAL BLADDER SYSTEM <br /> TYPE OF TANK MEMBRANE LINER ❑95. UNKNOWN <br /> (Chtak om hem only) 4. SINGLE WAI I IN A VAULT ❑99. OTHER AAA. <br /> ❑3. DOUBLE WALL ❑ 5. CONCRETE 95.UNKNOWN <br /> ARE STEEL 3. FIBERGLASS/PLASTIC 99.OTHER: <br /> TANKMATERIAL-pcecmY� 4_ STEEL CLAD W/FIBERGLASS ❑s. FRP COMPATIBLE METHANOL ❑ <br /> (Rat aR�mh) ❑' STAINLESS S[EEL ❑ W'/100Y.METHANOL <br /> REINFORCED PLASTIC <br /> 3. FBERG1A55/PLASTIC e. FRP COSffnBLE W/100Y.METHANOL 95.UNKNOWN M . <br /> TANK MATERIAL-fecotdary wok I. BARE STEEL 4. STEEL CLAD W/F'IDERGIASS ❑9. FRP\ON-CORRODABLE JACKET ❑99.OT}IER <br /> (Check one hem only) ❑2. STAINLESS STIDL❑ R NFORlCED PLASTIC(FRP) ❑ 10. COATED STEEL <br /> 5. CONCRETE 95.UNKNOWN A46. DATEWSTALLED 447. <br /> _ 3.EPDXY LINING 5.GLASS LINING <br /> TANKOR COATING DR LS`TLNG ❑2.RAS ANG ❑A.PHENOLIC LINtt'IG �UNLl ❑99.OTHER <br /> (Check ole he onlv) a48. 'DATE INSTALLED 'N9. <br /> OTHER CORROSION L MANUFACTURED CATHODIC ❑<.IMPR�EGSSIDSCURREO'RICID PLASTIC ❑99.OTHER <br /> OWN <br /> PROTI:Cf10N PROTECTION <br /> 3.SACRIFICIAL ANODE 45t. ILLONEQUIPMENT: YEAR INSTALLED ns <br /> fI liND YEAR INSTALLED 450. TYPE 1. ❑3.FILL TUBE SHUT OFF VALVE <br /> SPILL AND OVERFILL n BAy}-FLOAT-_ ❑4.�.1PT <br /> (Check all thatawb) 02.DROP CTUBET <br /> ❑3.STRIKER PLATE IV.TANK LEAK DETECTION <br /> (A description of the Incl 453. <br /> be sub pitted to the 10=1 agency.) 655. <br /> n53. ffDOUBI.E WALL TANK OR TANK WITH BLADDER <br /> IF SINGLE WALL TANK (Check cme item only) <br /> (Cheek all that apply) ❑5.MANUAL T (MIG) 1,GAUGING(MI ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) <br /> EYP <br /> [] 1.VISUAL( OSID PORTION ONLY ❑6 NODOSE ZONE ❑3.CONTINUOUS INTERSITTIAL MONITORING <br /> ❑3. AU CONTINUOUS <br /> ANK GAUGING(ATG) ❑7 GROUNDWATER ❑3.MANUAL-MONITORING <br /> ❑3.CONTB.l'OUS ATG <br /> ❑4.STATISTICAL DIVENN TORY RECONCILIATION ❑8.TANK TESTING <br /> (SIR)-BIE`AIAL TANK TESTING ❑99. OTHER �-- <br /> V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE <br /> us. ESTIMATED QUANTITY OF SUBSTANCE RE�IALNING nM. 7ANKflL1.ED WO 1 OT NoATER1AL? <br /> .n. <br /> ESTIMATED DATE AST USED(YR/MO/DAY) galiom <br /> Rev.02/16/00 <br /> UPCF hwfwrc-b(1199)-113 <br /> http://www.o nidocs.org <br />