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'01/02/2003 11:05 2095776040 BOYETT PETROLEUM O� PAGE 02 <br /> Q <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TA,N1fCS <br /> UNDERGROUND STORAGE 'WANKS-TANK PAGE i <br /> (two pages W,Link) <br /> Paan <br /> TYPE OF ACTION ❑1 NEW SITE PERMTT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OP 1Nr'ORMATION ❑ 6 TEMPORARY SrM CLOSURE <br /> (efierlt me hem only) ❑ 7 PERMANENTLY CLOSED ON SITE, <br /> i,LRENEWAL PERMIT 484mifyLeman-(brkKolanonly) (3p*6rymttann-forl0c1ilmeonly) ❑ A TANK REMOVED <br /> BUSS AME( err FA MF.oe n A-D 11na 3ualnw na) FACILITY ID: <br /> R 3Lo 5� <br /> LOCATION W SITE f0ol.0 471 <br /> I.TANK DESCRIPTION (A Mled plot pinn with the location ofthc UST"em including hwidings and landmarks shall be suhtritted to the local agcncy.) <br /> TANK ID# 412 TANK NUF L`TURB 411 COMPARTMENTALIZED TANK Ycs No 4,U <br /> O r 3.7 C) 1 f"Yoi'.tamdtte W.page rw even compufinent. <br /> DATE,TTQgTA1sLED,(YEAR/MO) 4,15 TANK CAPACITY IN GALL NS 41fi NUM$ER OF COMPARTMENTS It 41'1 <br /> ADDITIONAL DESCRIFTION(p,*Inal,aennty) f 438 <br /> ll.TANK CONTIENTS <br /> TANK USE 45a PETROLEUM TYPE 446 <br /> I.MOTOR VEHICLE FUEL ©14. REGULAR UNLEADED O 2. LEADED ❑5. =FUEL <br /> (lf compktePmrokamType) [jib. PREMIUM UNLEADED X3, DTE-SEL Q 6. AVIATION FUEL <br /> ❑2, NON-FUEL MTROLBUM ❑Ic. MIDGRADE UNLEADED ❑4, GASOHOL ❑S9.OTHER <br /> ❑3. CHEMICAL PRODUCT COMMON NAME((ftenn Ha=d.Materlab Imcmoty wuo) 4A1 CAS#(from '142Htmndooe MMra+�Si tnvewmry pnge) ' <br /> C34. HA7.,ARDOUS WASTE <br /> (IWILWUU�dCNQ L/'v`ti!`�-� <br /> ❑95.UNKNOWN Il/Y/ ! !L"• {�•,{{~ <br /> TIT. TANK CONSTRUCTION <br /> TYPE OF TANK 1. SINGLR WALL 3, SINCLE WALL WITH U 5. SINULE WALL WITH INTERNAL F,LADDE.R SYSTEM 445 <br /> (Check ono im.only) EXTERIOR MEMBRANE LINER [j 95. UNKNOWN <br /> A2. DOUBLE WALL ❑4. SIGNLr,WALL IN VAULT Q 99. OTHER <br /> TANK MATERIAL-primary wk U 1. BARE STEEL U 3. FIBERULASS/PLASTIC U 5, CONCRETE LJ 95. UNKNOWN '144 <br /> (Chock ono heat only) 2. STAINLESS STEEL C1 4. STEEL CLAD W/FTRERGLASS C]9, PRP COMPTIBLE W/100%METHANOL [199.OTHER <br /> RMNPORC12D PLASTIC(FRP) <br /> TANK MATR..RIAL-swoclmyttmk I, AARPSTUI, 3. MPROLASS/PLASTIC U 5. CONCRETE U 95. UNKNOWN '145 <br /> (check.-Item only) ❑2. STAINLESS STEEL O 4. STEEL CLAD W/FIBEROLASS ©8. FRP COMPTIBLE W/10046 METHANOL ❑99,OTHER <br /> REINFORCED PLASTIC(PRP) ❑10,COATRD STEF,L <br /> ❑5. CONCRETE <br /> TANK INTERIOR LINING 0 1.RUBBER LINED D.I.EPDXY LINING 0 S,GLASS 1,TNTNG, 95.UNKNOWN 446 DATE INSTALLED A47 <br /> OR COATING O 2 ALKYD LINING ❑4 PHIENOI.SC LININGAllUNI,TNPD ❑99 OTFMR - <br /> (Cwa me item only) (Fnr meal w mtly) <br /> OTrIPR COR.ROSTON Ca 1 MANUFACTURED CATIaODTC ❑3 F11BERGLASS REfNFORCPT)PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 <br /> PROTECTION IF APPLICA13LP PROTECTION [14 IMPRESSED CURRENT -9Z99 OTHER <br /> (Chock one Item only) ❑2 SACRIFICIAL ANODE t (Fa loenl,oa rnly) <br /> SPILL AND OVERFII,I, YEAR INSTALLEDI w TYPE(inert wee wy) 451 OVERFILL PROTECTION EQUMMENMY EAR INSTALLED -+ .152 <br /> (C1eck ell mat apply) �1SPTLI.CONTATNMFNT NI ALARM .-FILL TUBE SHUT OFF VALVE <br /> 2 DROP TUBI SALT.FLOAT ❑4 EXEMPT <br /> 3$TRTKER PLATE, <br /> IV,TANTO LEAK DETECTION(A d MNptlnn or he mrmnNms pmsnm"I[Mffi,hm ned to the 1-1 seney') <br /> IF SINGLE WALL TANK(Check all thn Awl y) 451 IF DOUBLE WALL TANK OR TANK WIT 14 BLADDF,R 454 <br /> L2eek one Item only) <br /> ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTO) 1 VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK CAUGTN(3(ATG) ❑6 VADOSP ZONE FirZCONTINUOUS TNTERSTTTIAL MONITORTNG <br /> ❑3 CONTINUOUS ATG ❑7 OROUNDW ATER ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAI,INVENTORY RECONCILIATION ❑6 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTTNG Q 99 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN FLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 6STIMATP.n QUANTITY OF SUBSTANCE REMAINING 4,56 TANK FILLED WITH nMRT MATERTAL7 dr <br /> gallons ❑Yea Q No <br /> UPCF(12/99 revised) 10 Formerly SWPC13 Form B <br />