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l (� o� <br /> UNIFIEDPROGRAMCONSOLIDATEDFOR 11�� TANKS <br /> UNDERGROUND STORAGE TANKS-TANK CuIv <br /> (hro pages per tank) <br /> Page <br /> 5. CHANGEOFINFORMATION) <br /> ❑ ❑ 8. TEMPORARY SITE CLOSURE 1 O <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT U 4. AMENDED PERMIT ❑ ]. PERMANENTLY CLOSED ON SITE I <br /> (Check one dem only) <br /> ❑3.RENEWAL PERMIT (SpppHyraaspnbrlacal uae ary9 (SpeNycMrpe-brladluse onM8. TANK REMOVED 430 <br /> 1 <br /> FACILITY IDM - l S Z <br /> BUSINESS NAME(Semmes FACILITY NAME or DBA-Ming Business As) l <br /> k( � rr� S <br /> LOCATION WATHIN SITE(Opfionel) 431 N 1 I n /( / ` <br /> /�1 P/ rt ✓ L ! <br /> '� 1 1.TANK DESCRIPTION <br /> TANK ION TANK MANUFACTURER COMPARTMENTALIZED yer.mTANK ❑Yes U Na <br /> II'Vas',mmplate one page for each compaNnent <br /> RAAO) <br /> J TANK CAPACI YIN GALLONB NUMBER OF COMPAR <br /> DATE INSTALLED(YEAMEN S <br /> ADDITIONAL DESCRIPTION(Ferbcal use OW <br /> If.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE ❑❑ 2. LEADED S. JET FUEL <br /> ❑ 1.MOTOR VEHICLE Ula. PREMIUM UNLEADED U 3. DIESEL ❑ e.AVIATION FUEL <br /> (Il merNM,rompkN pelmhaum fmNum type) 0 1p. PREMIUM UNLEADED [IN. OTHER <br /> U 2. NON-FUELPETROLEUM U to MIDGRADE UNLEADED U 4. GASOHOL <br /> U 3.CHEMICAL PRODUCT COMMON NAME CAS M(Tmm HazeNous Meknals Inwnlprypage) <br /> (M1om HazarEous Metenals Inwnforypags) <br /> ❑ 4. HAZARDOUS WASTE(1MM <br /> UNC 00 <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLEWALL U 3.SINGLEWALLWITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> EXTERIOR MEMBRANE LINER U95. UNKNOWN <br /> lch oee lmm only) ❑ 2. DOUBLE WALL U 4. SINGLE WALL IN A VAULT U 99. OTHER <br /> TANK MATERIAL-pnmary lank U 1. BARE STEEL <br /> ❑ 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN <br /> (LAsck mre kem any) ❑ 2. STAINLESS STEEL ❑4. STEEL ❑ 8. FRP COMPATIBLE WI100%METHANOL ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-aacoMary lank U 1 BARE STEEL U 3. FIBERGLASSIPIASTIG ❑ 8. FRP COMPATIBLE W/100%METHANOL ❑95. UNKNOWN <br /> (CMLN o'rs ihm any) U 2. STAINLESS STEEL U 4. STEEL CLAD WAMBERGIASS 09 FRP NOWCORRODIBLE JACKET U 99. OTHER <br /> REINFORCED PIASTIC(FRP) U 10 COATED STEEL <br /> ❑ 5. CONCRETE <br /> GATE INSTALLED <br /> TANK INTERIOR LINING U 1. RUBBER UNED U 3. EFOKY LINING U 5. GLASS LINING 1195, UNKNOM433 <br /> ORCOATING U 4. PHENOLIC LINING 06. UNLINED 099. OTHER Fwlroel use and <br /> 11 2. ALKYD LINING - DATE INSTALLED <br /> Check.itema ) <br /> OTHER CORROSION U 1. MANUFACTMREOCATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC 095. UNKNOWN 434 <br /> PROTECTION IFAPPLICABLE PROTECTION r-I IMPRESSED CURRENT U99. OTHER (Forbcal use Dory) <br /> (Check mm Hem Dray) U 2. SACRIFICIAL ANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> SPILLAND OVERFILL - YEARINSTALLEO TYPE(Forbol use orry) <br /> lChsckatl Natappy) U 1, SPILL CONTAINMENT U 1. ALARM U 3. FILL TUBE SHUT OFF VALVE <br /> U 2. DROP TUBE - U 2. BALL FLOAT__ U 4. EXEMPT <br /> U 3. STRIKERPLATE <br /> N. TANKLEAK DETECTION. <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item on ): <br /> IF SINGLE WALL TANKCheck ell that ep ): <br /> U S. MANUAL TANK GAUGING INTO) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ e. VADOSE ZONE <br /> U 3. CONTINUOUSATG - U i. GROUNDWATER ❑ 3. MANUAL MONITORING <br /> U 4. STATISTICALINVENTORY RECONCILIATION(SIR) U 8. TANKTESTING \ <br /> BIENNIAL TANK TESTING U99. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRIMO/DATI ESTIMATED QUANTITY OF SUBSTANCE REMAINING <br /> 435 TANK FILLED HATH INERT MATERIAL? <br /> \" `r D✓� �/�/ // / palbm ❑Yes U No <br /> Formerly SWRCB FOITI B <br /> CUPAFORM(4/99) <br />