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JUI,-05-00 WED 11 16 AM ENVIRONMENTAL MGMT DEPT FAX NO, 9168758513 P, 02/03 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANKS-TANK PAGE I -, TANKS <br /> Papa d _ <br /> TIPS OF,1Crgla L3 I. NElY91E PERMITO a.AMENDED MFM, ,�S CNMMCF&PORMATC" 0 E 7811FICIPARYSITEC60I <br /> I[UMatem amw o•M <br /> � 13 <br /> PERYR7. PFAMAlENRY CLDSEDON BIE <br /> ❑ A TAME RYLIWm OO <br /> ESS NAPE(SYn las F.ICILRY - g,mr�so 1 3 FaQ)ry D/ <br /> V\IAI K. (A�i NA p 'e V43 Ca <br /> IDCATK7N IYTIRN SRE Cp&wW I t 1 c �1e ut <br /> SIc�eWzt ctt v.TRay.c l� /.� o G� . i�La-tom S� Sf0 <br /> I.TA14K DESCRIPTION <br /> AN <br /> IQ G YANuACr OWPARTWNTAL®TAM( ❑ T. NO Ay <br /> kKoUL)t u, r H.OW k rtTaa•,rm,yaY ena P9afar aaneNllP.m,�a, <br /> (Y ) ANR IN S N R <br /> VA-6 W U%- <br /> AIM- ve <br /> G.TANK CONTENTS <br /> TANK USE ASG PETROLEUM TYPE <br /> 4D <br /> I. MOTOR VEHICLE FUEL ❑v. RFGLAAR UNlFA0E0 0 2.LEADED 0 S ,TET FUEL <br /> afOrM�1Y00.eaegbm APDYYn TTPa) <br /> All. NCNSUEL PETROLEUM ❑1D. PREMIUM UNLEADED C 3. DIESEL 0 S.AW'DpN <br /> 0 3. CHEMIQALPRCDUCT 0 tc W0GRLI)C UNLEADED ❑ 4.GA5St0L gg, OTHER r e \1 OI <br /> ❑4. l OOUS5Y44TE(/item COMMON NAYElAdn MailNouf�jalaaAllamwr^,YP(9/a)�\ ut (!.•i(apmlROrtAyaANmnew anSVPPY PPI 44Z <br /> CGS UNMOWN e Zt IIA \l I l <br /> IB.TANK CORSTRUCTION <br /> TYPE OF TANG SINGLE WAIL ❑ 3. SINGLE WALL WTH <br /> O 9 SINGE WALL N TH INTERNAL III ODER SYSTEM 4u <br /> (CSaPrPP Nem aHyl ❑ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> C 4. SINGLE WALLIN A VAULT 13 W.OTHER <br /> TANK MATERIAL-Pnm am01- BARESMEL C I FlBERI:;Uss r PU5TIC <br /> 05 CONCRETE ❑GS_ uAxwowv <br /> (DAw-taY Kam PM') C 2 STAINLESSSTEEL C A. STEELCUO C 0. PRPCOMPARBIEwi,XI%METHANOL 09R OTHER <br /> WIRSERGLASS <br /> REINFORCED PLASTIC <br /> TANK YATERYL-samgv/ON;C . BMESTFEL C 3. FIBERQ Ac<l PLASTIC 00.PRP CDMPATBLEWiYDDY.YETFVLNOL ❑9s. ummwamN <br /> 44b <br /> (Ca4al erw mrn aNy) `1 C z STNNLE$$STEEL 04. STEEL CLAD INPRERGLAS`, 0 9. FRP NpNODRRoaB1E JACKET ❑99. OTHER <br /> Iv A REINFORCFDMYTC(FRO) <br /> 0 ❑10. COATED$TEFL <br /> 5. CONCRETE <br /> TANK N�RIDR LdLVG ❑ RUBBER LINED PATE INSTALLED uT <br /> OUCdLTING ❑ 3, EPDXY LINWG S. Gu55l.IMNG C95. UNKNOWN m6 <br /> ow came <br /> C Z.ALKYO UNING 0 4 PHENOLIC LINING a. UNLINED ❑9B. OTHER <br /> OTHER CORROSION �1ia <br /> PR OTECTIONIFAPPLICABLE O ' MANUFACDpiFD cATHOOC 03. SURG(ASS REINFCRCED PINTIC �31 UNKNOWN 444 DATE INSTALLED 449 <br /> PROTECTION <br /> fCM .AI ,..Yj C ' SACRIFICIAL ANODE C 4. IMPRESSEDCURREM 99. OTHER <br /> (Fv Ap15A�OaN <br /> SPILL AND OVERFILL YEARINSTALLED x011 T E(FPIAmI.,W 451 OVERFILL PROTECTION EOUIPYENT:YFM INSTALLED 43 <br /> (CAeGMmYeyPyf ❑ - sOILL CONTAINMEM ❑ 1. . RY C 3, FILL TUBE SHUT omIIv LVE <br /> V�o K e ❑ 2 ORO`TUBE ❑ 2 SAA FLOAT__ C 4. EXEMPT <br /> C ! STRIKER M vc <br /> IV. TANK LEAK DETECTION <br /> Y SINGLE WALLTANK reno,a0 mal appy): AID IFDDU61.EWALLTiNRORTAM[BRTNBLAMMCCMe ;Z--n 4s4 <br /> 0 t, VISUAL(EXPOSED PORTON CNLYI MNVyAL TANK GAUGING R4TG1 C T. V*UAL(SINGLE WALL INVAULT ONLY) <br /> C 2 AUTOMATIC TANK GAUGING;ATG1 0 B. VAOOSSE ZONE ❑2. COMOAAIb INfERSTRMI mOMTORING <br /> 03- CONTINUCLISATG C T. GROUNDWATER ❑ 3. NANUALYOMTORPG <br /> 4. STAMI Cn IN NTORY RE=NOUATION(SIR)- C B. TAHKTESTING <br /> BIENNUL TMIK TESTING W. OTHER <br /> V.TANK CLOSURE INFORMATION J PERMANENT CLOSURE IN PLACE <br /> ESTIYATEODATE USED(YRnGOAr 455 ESRNATEO ODAKITTIY O<SUBSTANCE REMAINING 450 TANK FILLED Wl'N INERT MATERW.T AS/ <br /> LA. k VLO u)N Assn ewes <br /> UPCF(1/99) q" ❑7YomNp <br /> a 1- y�A t lv&�'J//yg <br /> FonRerry S'MiCB Form 8 <br />