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UNIFIED PROGRAM CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br />TYPE OF ACTION ❑ 1. NEW SITE PERMIT ❑ A. AMENDED PERMR IX 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE <br />(CAaptlAwaa'MT _ _ <br />13 3. RENEWAL Nllyl ( Plop-/Oy,eK* NWX1 Cl 5. TANXREMOVEO OSED ON SITE <br />PERMIT ( Aeson-��� OO <br />BUSINESS MIMEE\(\(Sarre, u FACILITY NAME DBA- Ooep Buvrea"1 3 <br />FACIUTY ID! <br />- <br />1 <br />1> <br />LI <br />1 <br />LOCATION WIR9N SITE (OPO.W <br />U1 <br />1. TANK DESCRIPTION <br />K 10 a 132 <br />TANKMAN.LFACTURER <br />1a1 <br />ap <br />COMPARTMENTALIZEDTANK ❑ Yes No <br />CM <br />L <br />0 <br />IIDATE -Yas', mnPlNe me Doge ld eePl FeMlenl <br />INSTALLED (v ) 135 <br />ANK CAPAC^ITY IN 5 <br />138 <br />NUMB R FCOMPARTME <br />U] <br />['� <br />IR (o <br />I L Doo <br />ADD:.g CESCPjP^,ON IFw:oc'uso ,er1 <br />II. TANK CONTENTS <br />TANK USE 139 <br />PETROLEUM TYPE <br />aa0 <br />YOTCR VEHICLE FUEL <br />❑ 1a. REGULAR UNLEADED ❑ 2. LEADED <br />❑ 5. JET FJEL <br />(L,=T1. <br />oeararte Petm. Type) <br />Cl It, PREMIUM UNLEADED ��y�� <br />IPS DIESEL <br />❑ 6. AVIr3TgN FUEL <br />❑ 2. NONFUELPETROLEUM <br />❑ is MIOGRADE UNLEADED ❑ A. GASOHOL <br />Cl N. OTHER <br />❑ 3 CHEMICAL -PRODUCT <br />COMMON NAME Ih He,... Maeerws -.-mol page) <br />Hl <br />CAS a (hie HiZ"ous Mama.. Mvenfay Pagy <br />e,2 <br />❑ A. HAZA14000S WASTE ll d . <br />Uses OO <br />❑ 95 UNKNOWN <br />Mi. TANK CONSTRUCTION <br />TYPE OF Tari( 0 1. SINGLE WALL ❑ 3. SINGLE WALL WITH <br />Cl 5. SINGLE WALL NTH INTERNAL BLADDER SYSTEM <br />W <br />(Cle,Ptae, hem eW) 2. DOUBLE WALL EXTERIOR MEMBRANE LINER <br />095. UNKNOWN <br />❑ A. SINGLE WALL IN A VAULT <br />❑ 9B. OTHER <br />TANK MATERIAL pnmery UKII V 1 BARE STEEL Cl 3. FIBERGLASS / PLASTIC <br />❑ 5. CONCRETE ❑ 95 UNKNOWN <br />14A <br />([kept Ore, w Orly) ❑ 2. STAINLESS STEEL ❑ 1. STEEL CLAD <br />❑ 8. FRP COMPATIBLE WIIW%METHANOL ❑99. OTHER <br />WIFIBERGLASS <br />REINFORCED PLASTIC FRP <br />TANK MATERIAL. som yMM Q 1 ARE STEEL %3. FIBERGLASS/PLASTIC <br />❑ B. FRP COMPATIBLE W/100%METHANOL 095. UNKNOWN <br />aas <br />(cheat ae, ram only) ❑ 2. STAINLESS STEEL ❑ a STEE-CLADWMISERGLASS <br />❑ 9. FRP NONCORRODIBLE JACKET ❑99 OTHER <br />REINFORCED PLASTIC(FRP) <br />010 COATED STEEL <br />❑ 5. CONCRETE <br />TANKINTERgR UNING 1. RUBBER LINED Cl 3. EPCXY LINING <br />❑ 5. GLASS LINING ❑ 95. UNKNOWN 118 DATE INSTALLED <br />eat <br />OR CO.nNG <br />Cl 2. ALKYD LINING Cl 1. PHENOLIC LININGS. <br />UNLINED 13 99 OTHER <br />GBM merem OrN <br />Fdloolu+e 1 <br />OWER CORROSION ❑ 1. MANUFACTUREDCATHODC ❑ 3. FIBERGLASS REINFORCED PLASTIC Ll 95 UNKNOWN IAB CATEMSTAa O <br />119 <br />PROTECf1ON IF APPLICABLE PROTECTION Cl 1. IMPRESSED CURRENT <br />Cl 99. OTHER <br />fCMrA ar rem er✓YI ❑ 2. SACRIFICLAL ANODE <br />(Fabwl use omy) <br />SPILL ANOO ERFILLpp YEAR INSTALLED 150 "PE(Forlogluse*Ny) <br />451 <br />OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED <br />.0y)152 <br />(CtaKe arl roar ay) P�Aa 1. SPILL CONTAINMENT <br />❑ 1. ALARM �Z <br />3. FILL TUBE SHUTOVALVE <br />Z FF <br />yD 2 . DROP TUBE <br />pp <br />O <br />2. BALL FLOAT �O Cl a EXEMPT <br />fo 3. STRIKER PLAW <br />N. TANK LEAK DETECTION <br />M MNGI.E WALL TANK (Check am mat appy) <br />153 <br />IF DOUBLE WALL TANK OR TANK WRH SLAI2DER (Cheat ale ems dey) <br />a51 <br />❑ 1. v'S'_�IEXPOSEDPORTIONONLYI ❑ 5. MANUAL T.'.( GAUGINGIMTGI <br />❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br />❑ 2 Ay.JMATIC TANK GAUGING(ATGI ❑ 6. VAOOSE ZC`.E <br />42. CONTINUOUSINTERSTITIALMONITORING <br />❑ 3. CCNTNODISATG ❑ T GROUNDAA-ER <br />❑ 3. MANUAL MONITORING <br />❑ A S-OSTICAL INVENTORY RECONCILIATION MSIR!• ❑ 8. TANKTESn NG <br />SIE%lx TANK TESTING Cl 99 OTHER <br />V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br />ESTIMATE- ]ATE LAST USED IYR/MO/CAYI 155 ESTIMATED QUANTITY 2= SUBSTANCE REMAINING <br />158 TANK FILLED NTH INERT MATERIAL? <br />AST 1 <br />gallons <br />❑ Yes ❑ No <br />UPCF 0!9> Formerly SWRCR Form 8 <br />