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JUL705-00 WED 11 : 16 AM ENVIRONMENTAL MGMT DEPT FAX N0, 9168758513 P, 02/03 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 TANKS <br /> _ RiNI� <br /> TYPE OF AGTIC IN Q 1, NLW;M PERM" ❑ 4,AME 90M PERU pap d <br /> RAlgrPrr.. CKANGEMINFORMATICN) ❑Q TEIKawuxY Nm3. MSifE — <br /> PFRII"ENEML ❑ 7. PER%yN` LTf1ffiEDO.S"E <br /> �� as 0& TANf REMOVED <br /> ESS NAME Isae,Y FACILfir YIIE o- 00 <br /> LI wv ] FACATTTO• <br /> LOGTI011WT)PN SLTE Ct,arO <br /> S1�1ewa� C vA_kRaV..Ie o, <br /> I.TANK DEgORIp}pN <br /> AN I K ANR YANU <br /> CN1P"RIMFR]V'TµIffDmV�M ar pp.mrTiaT mno,renwc � <br /> W Plis (Y 1 MIK W S <br /> HU R <br /> kin V`O w Lr` SSo l <br /> AOORIOWLL DESCR,MON(FVIPPMw PNT) <br /> a TANK CONTENT$ <br /> TANK USE 6 PETROLEUM TYPE <br /> Q 1. MOTOR VEHICLE FUEL Cl 1]. REGULAR UNLEAOM ❑ 2. LEAOBD <br /> fepevep.P>•+abe pf p type/ ❑ S JET FUEL <br /> )0-. NOISUEL PETRN-EEUM Q1p. PREIWUM UNLEADED Q J. DIESEL. ❑ 8.AVMTpN 1 <br /> Q 1 CNEMBCCLFRocucT Q 1, wocR wUNLEADED ❑ A. GASCIC, A90. OTHER \1 Ol <br /> ❑ A RASARCOUs WASTE tj d COMMON NAME 1N HRz, M 1MNANs mwnmyaW/ ut Ca5 K APm <br /> um OM) (/'�� f wnlm,M Meenae mlVle'li?M A4 <br /> ❑BS. UNgiOWN e I ti q �J T <br /> IIL TANK Coim—Lici circ <br /> TYPE OF TUM <br /> SINS WALL ❑ 3. sINGLE WALL`NTN Q $ SINGE WALL VBMINTERFLY BLN[roER SYSTEM <br /> ([4N'PIN Hem on71 <br /> CZ DOUBLE WALL EXTERICR MEMQFVAE UWR 095, uNLDHDVM 1.1 <br /> Q.. SINGLE WALLIN A VAULT <br /> Q W. OTHER <br /> TANK MATERIAL-pnlnry Milk WESTEFl <br /> ❑1 F®ERGLA55/PW`TIC Q 1 WNCRETE LJ i UIdWOMY µ� <br /> IOwet Pre mmH arvy) Q i STAINLESS STEEL ❑ .. STEELCUD <br /> WAIIBERGLASS ❑ B. FRP OOMPAnBLE YNGp�METiYNCL ❑gp- OTHER <br /> TANK YATERML-yemlyry hNt REINFORCED PASTLG FRP) <br /> ❑ ' BARE STEEL ❑3. FBERG.ASS I PULSTIC 08. mppOMPATBLEV/Iw%MEfHAN01_ ❑w UNKNOWN <br /> (CAe!are Bern edyl +.S <br /> ❑ v STAINLESS STEEL Q a SCLAD WIFlLp <br /> BERGrs ❑ 9. FAP NONZORROOIE JACKET <br /> OP9. DTHER <br /> A TEEL <br /> REINFGgCED PLABTC F", <br /> ❑ 5. CLNCRETE ❑ip.COATED STEEL <br /> TANK INTERIOR LmNG Q •. RUBBER UNDO <br /> ORCCATING ❑1 EPOKYUNWG 0.5. GIASSUNING 1295. UNKNOWN yE DATE WSTALLED uT <br /> alelrl,P OZAUTO LINING Q1. PHENOLIC LWING �a. UNLINED ❑Vp. OTHEt <br /> OTHER <br /> CORROSION Afol m enN <br /> PROTECTION IF APPUCABL Q I MANUEACiIIIiID OkTNCOC ❑ 3.FRIERGUSIS REINFORCED PLASTIC '�$T31 UNKNOWN A{B DATEINSTy IAB <br /> TECTA Q 4 IMPRESSEDCURRENT (] <br /> (CMer awe ARn oryJ ❑ ' SACRIFlCML ANODE 99. OTHER <br /> SPB3-AND OVERFILL (Fo-�,M•o-0) <br /> YEAR INSTALLED .SD TYPE(FarHsa/m P,Vy) 151 D L.PROTECTION ECUPMENTT YEAR INSTALLED 132 <br /> ATSN*apmr,+PAYY) ❑ ' SPILLCONTMNMENT 0 t ALARM ❑ 3. FlUTUBE SHUT OFF V4YE_ <br /> V\ O ❑'. OROP TUBE C 1 BALL FLOAT <br /> e Q.. EXEMPT <br /> C 1 STRIKER PLABF <br /> N. T"U'LEAK OETECTION <br /> IP`"NCE WALLTANK(Dnd RKfw.ppry)- tS3 6000BLE WALL TANK OR tANK W(M BLADDER ICn.Ys ere.eR,ary: H51 <br /> ❑ 1. VISuy (woSED PoRTION_NLYI MUIUAL TANK GALGING(WIG] ❑ 1. VISUAL(SINGLE WALLINVAULTONLY) <br /> Q 2- AUTOMATC TAN(GAUGING:iTG) 0 B. VAOOSE 20NE _ ❑2. CTxIIWUGLb INfEFiST"MLMbaiOglNG <br /> ❑3 =NRNUCUS ATG ❑ 7. GROUNDWATER _ ❑ 3. NKNUALMOMTOAMC <br /> D l STATISTICAL INVENTORY RE TOWTONISRI ❑ B TAHKTEM S <br /> BIENNIAL Aepc TESTING <br /> ❑99. OTHER <br /> V_TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> (.l.V.I(Inoo u1) <br /> ESTIAu7E0 CUTE USEDA. LA l55 FSTMATEOOVANr"YCFSlJMTANCEREMUMNG y TANK FILLED WfIIH WEPT MATFAULLT <br /> 1+7 <br /> ---------------------------------- <br /> a ve ❑Y0 <br /> Iw <br /> UPCF(1)99) <br /> Fotmm)y SWRC9 form S <br />