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Iw <br />oa <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND STORAGE TANKS • TANK PAGE 1 <br />neo wmw <br />papa L a <br />TYPE Of ACifON ❑ 1. NEW SRE PERMIT ❑ 4. AMENDED PERMIT 5. CHANCE OF INFORMATION( ❑ 6. TEMPORARY SITE CLOSURE <br />(CAaoa...w ❑ T. PERMANENTLY CLOSED ON SITE <br />C3 . RENEWAL(Sproryleasoo-M1S rod Ms anry) (pecoy teMh9e-ho, bd Ree 3W) ❑ a, TANK REMOVED m <br />PFYMIT <br />SUSRESS NAME (S4ma asFACILITY NAME a I&A -Deep Buawhim") 3 <br />FAC4I1Y ID / <br />- <br />1 <br />/ ( / <br />LOCATION M(THIN SITE (OP60W <br />411 <br />1. TANK DESCRIPTION <br />ANKI a 432 <br />TANK MANUFACTUR R <br />433 <br />COMPARTMENTAIJZEDTANK ❑ Ysa No <br />4T4 <br />If a` mnPel. ma p"alweatA rti <br />6 (! l <br />DATE INS N ) a35 <br />TANK CAPACITY IN GALLON$ <br />436 <br />NUMBER FCOMPARTMENTS <br />VT <br />gL9 <br />1 2-x QQn <br />nD.wiidrY DESCRIPTION(For l JY; <br />r"K' <br />11. TANK CONTENTS <br />TANK USE 439 <br />PETROLEUM TYPE <br />ab <br />1. MOTOR VEHICLE FUEL <br />❑ ia. REGULAR UNLEADED ❑ 2. LEADED <br />❑ 5. JET PJEL <br />Nmallo, ReunslN Polmleuln Type) <br />C1Is PREMIUM UNLEADED 1%3. DIESEL <br />❑ 6. AVIATIONFUEL <br />❑ 2. NON -FUEL PETROLEUM <br />C1 I., MIOGRADE UNLEADED C34. GASOHOL <br />C1 W. OTHER <br />❑ 1. CHEMICAL PRODUCT <br />COMMON NAME(ham Haesleaus MaferMls lnronlory pa9e1 <br />I Arene HaialEaua MiM1nMe ImeMW pepel <br />U1 <br />134. HAZARDOUS WASTE IlMuees <br />Use DO <br />7AS <br />❑ 95 UNKNcvvN <br />111. TANK CONSTRUCTION <br />TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL HATH <br />❑ 5. SINGLE WALL WITH INTERNAL BUDDER SYSTEM <br />W <br />EXTERIOR MEMBRANE LINER <br />ale 4em <br />(CMtel only) 92. DOUBLE WALL <br />0 95. UNKNOWN <br />❑ 4. SINGLE WALL INAVAULT <br />13 _ OTHER <br />TANK MATERIAL. primary Rare 1g I SAttE STEEL ❑ 3. RSERGLASS/pIASnC <br />❑ 5. CONCRETE C3 95. UNKNOWN <br />4u <br />/ <br />(CIIeOt ole can only) ❑32. STAINLESS STEEL ❑ 4. STEELCLAD <br />❑ S. FRP COMPATIBLE W/100%METHANOL ❑99. OTHER <br />WFIBERGIASS <br />REINFORCED PLASTIC FRP <br />1MqIss <br />TANK MATERIAL - Semnoary Fare 01 BARE STEEL aq3. FIBERGLASS/PIASTIC <br />06. FRP COMPATIBLE W/100%METHANOL C3 95 UNKNOWN <br />445 <br />(Chealale,.hly) ❑ 2 STAINLESS STce_ ❑ 4 STEECIADWFIBERGLASS <br />❑ 9. FRP NONLORRODIBLE JACKET C1 99 OTHER <br />REIN-ORCED PLASTIC(FRP) <br />010. COATED STEEL <br />❑ 5. C@CRETE <br />TANK INTERIOR LINING 1 RUBBER LINED ❑ 3. EPDXY LINING <br />❑ 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED <br />uT i <br />OR connNG <br />❑ L ALKYD LINING ❑ 4 PHEWJLIC LINING <br />�, 8. UNLINED 0 9. OTHER <br />Chea,. aero aril <br />Fwlaol use ory I <br />OTHER CCiRt51`::' ❑ 1. YIANUFACT'JREO CATHODIC 3 FIBERGLASS REINFORCED PLASTIC ❑ 95. U::KNO'.1N :a5 DATE INSTALLED <br />u9 <br />PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT <br />❑ 99. OTHER <br />(Ghee oYelT arNY) ❑ Z. SACRIFICIAL PNOOE <br />(For boluse oayl <br />SPILL AND C':ERFILL YEAR INSTALLED 450 "FE (For loal use only) <br />151 <br />OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED <br />452 <br />p� 1 SPILLCONTAINMENT <br />❑ 1 ALARM 9Y 3. FILL TUBE SHUT OFF VALVE GZ <br />vy a(Chehe. eater) ysl <br />cc_ <br />2. DROP TUBE <br />o/ <br />2. BALL FLOAT __A_,_C14 EXEMPT <br />�O/�� <br />3 STRIKER PLA7i �i2 <br />N. TANK LEAK DETECTION <br />ff SaN6LE WALL TANK (Checa au that away) <br />a53 <br />IF DOUBLE WALL TANK OR TANK WITH BLADDER (Ch. one item y: onl <br />45a <br />C2 1, .,SLY,EXPOSED PORTION CNLYI ❑ 5. MANUAL TA'.,.AUGING IMTG) <br />❑ 1. VISUAL (SINGLE WALLIN VAULT ONLY) <br />❑ 2 A,FOMATIC TANK GAUGING (ATG1 ❑ 6 VADOSE ZC\E <br />X. 2. CONTINUOUS INTERSTITIAL MONITORING <br />❑ 3 CCM1 ,N000S ATG ❑ T GROUN014"ER <br />❑ 3 MANUAL MONITORING <br />4 S-_nSTCALINVENTORY RECCQNCIUATION(SIR')- ❑ B. TANKTEST ,G <br />BIENNAM TANK TESTING ❑ 99 OTHER <br />V. TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE <br />ESTIMATE- =ATE LAST USED (YR/MOVI 455 ESTIMATED OUANTI1 _= SUBSTANCE REMAINING 4% TANK FILLED WITH INERT MATERIAL' <br />49 <br />galbne <br />❑Yes ❑ No <br />UPCF I` Formerly SVVRCS Form B <br />