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<br /> FERM11 A.P.PlAC'ATION--TANK INFORMA
<br /> low,
<br /> -)v, dS ti IN/,and EX fir. i
<br /> TY11170FACTION (Cliechollcileill')I-Ify, Fol,',III UST pcnnallent.closur(ll Vt'relii( ji.colinpictcorty this tion an .cc ions
<br /> 30
<br /> !D PFRA41T 5,CHAN(if:OF IINFORMATION
<br /> 1.Nuw PERMT 8.(.IST R I.:MOVA-1
<br /> U.6.TEMPORARy UST C1,0STRU.. T71 7:
<br /> DATE CLOSE]l
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<br /> i'lVILITY R)17(/fgclje-.!,Use Olrly
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<br /> ,61 --------------- ..........
<br /> 10cd
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<br /> fLTANK)DESCRIPT,YON
<br /> 7 FA;W-(:(-INF�01 IRATiofT: Tins TANI(N
<br /> TANK ID V I'ANK MANO!-ACTI IRFIR - I.A sTAND-ALONE TANK
<br /> Vj2 ONE IN A COMPARTMENTFI)UNIT.
<br /> Com061= iormch compartment it,the unil.
<br /> -MENTS I N T11 I F IN 1 i
<br /> N UMBER_(�;COMPARI
<br /> DATI 435
<br /> ---------- ff..TANK USE,AND CON'TEMPS4
<br /> 'AN K I JSF 1b.MARINA FUFI-ING ❑ 1c.AVIATION FUE[AlIG,
<br /> t�la.MiTW�11 VFITIE- oil) jjI 5.IzMP-.R(ff-,NCY(3r-,T,[F.qATR F!ITU.(TISC.§252RI.5(e)l
<br /> El
<br /> 1-1 6.OITIER GENERATOR FUF)- 95.UNI Ij 99.OwER (specify):
<br /> 0
<br /> CONTENTS, PETL.
<br /> 3.DIESEL 1 j5.JF.,1,m IF.,1, ❑ 6.AVIATION GAs 440a
<br /> Ll S.PETROLIL] 9.OITIER PETROLEUM
<br /> -NjjN-PpNROLET IM:0 T 1 JSF.Jl,011, ❑ 4401,
<br /> ❑ ii.o,ri-TERNON-Pf."'rRoI.,I-IlJM 8 wi
<br /> TV. TANK-CONSTRUCTION
<br /> 'I'YPE OF TANK WAjI_1K 7.DOUBLE WALL ❑ 95.UNKNOWN
<br /> PRIMARY CONTAINMENT D TiFF-n. V T.FIBERGLA&S, ❑ 6.INTERNAL.ERNA[,BLADDER 444a
<br /> ❑ 7 STEEL F INTERNAL LINING El 95.1.��KNOWN [1 99.OTHER (Spccft�. -----
<br /> [I 7.JACKFT 445
<br /> --A-3I:IBFRG1 AS,, E9TERIORMEMBRANFLINER -1 D
<br /> ,,ri:()�iDARY CONTAINMENT El I-�TrFl, 441a
<br /> El 90.NONE ❑ 9.5.UNKNOWN El 99-OTHFR(Specify
<br /> n _u,FLOAT
<br /> 3.FILL TUBF SHUr-OFF 452.
<br /> -F)x-,j7RFILL_mRrwEN-I'101,1 ❑T.AUDIBLE.&.VISI JAL ALARMS _-2,ji;�
<br /> V, PRODUCT WASTE PIPING CONSTRUCTION
<br /> CONSTRUCTION�C----- 0.L-,fNGJE'-WALLI:D �.1�0141317- 99.ffrfifik
<br /> SYSTEM -SSURE El 2.GRAVITY 0 3XONvrNTJoT,1.ALSUCTION F-1 4.SAFE SUCTION J2
<br /> TYPE I.PR I
<br /> -7-RFM-ARYC0NfX-1NMFNT D-1-S"-IT "4-F1HJ-R(;LA. nR.FLEX
<br /> IBLE
<br /> LI O�RIGID PLAsTic90.NONE. W 9S.UNKNOWN F 91.OTTER(Speciry):
<br /> 464.,
<br /> 4(Ab
<br /> SECONDARY CONTAINMENT F 1.STEEL g4E10.RIGID PLAS PIC
<br /> 4(Ae
<br /> [] 90.NONE E] 95.1 JNKNOWN F1 99.OTIER.(Specify): El go.NONE -464d
<br /> PIPING/TURBINF.CONTAINMENT SUMP TYPE, tff I.SINGLrWALT. I LJ 2.DOUBLE WALL
<br /> VI.VENT,VAPOR RECOVERY(VR)1t ND RISER I FILL PIPE PIPING CONSTRUCTION
<br /> -4 464e
<br /> VFNT PRIMARY CONTAINMENT Ij I.STEEL PLASTIC [1 99.OTHER(Specifl
<br /> 0.RIGID PLA,TI 464c1
<br /> 1.-STFrTrj 4 RIGIDPLASTIC 0.�NO NONP,�099.3 171�IER(Specify) 4641
<br /> .NT SECONDARY CONTAINMENT 4641(
<br /> -NONIE] 99 iTITIJ-FR(Spc�--�f) 4(Ag
<br /> T.E
<br /> -.TI;FP PRIMARY C(�NTA5 r 10.RIGID PLASTIC 4645I
<br /> STFff, ------------------------------
<br /> ------- 1) STIC 90,NONE 99:(�YrHE (Specify) 464b
<br /> VIZ SECONDARY CONTAINMENT -1 4.rILIFROLAss IO.RIGI PLA 464bI
<br /> IEN PIPING TRANSITIONSUMP TYPE 0 L INGLE WA
<br /> -fC------ff-,�.DOUBLE WAT.1- 90,NONE 464'..
<br /> S
<br /> --R I.s f-I 10.RIGID PLASTIC U 90.NONE Lj 99.OTHER(Specify) 464i
<br /> RISER PRIMARY CONTAINMENT ,Trra, n4.I L/� 90.NONE 0-99.OTHER(Specify) 464j1
<br /> 464k
<br /> STE
<br /> 'T
<br /> T 0 .F113F,
<br /> --R-J,IFFR SECONDARYCONTAINMENTxxiXss D To.RIGID PLASTIC 46*1
<br /> -FILL-COMPONERrs INSTALLED— 1.WILL BUCKLA' 3.STRIKER PLATE/BOTTOM PROTECTOR 0 4.CONTAINMENTSU-MP --' 451-
<br /> M UNI ER DISPENSER CONTAINMENT(UDC)
<br /> CONSTRUCTION TYPE., ❑ 2.DOUBLE WALL, ❑ 3.NO DISPENSERS E] 90.NONE 46911
<br /> 4691)-e
<br /> CONSTRUCTION MATERI��L, I.STE 10.RIGID PLASTIC U 99.OTUFR(Specify)
<br /> 0 4.FIBERGLASS F
<br /> "I. CORROSION PROTECTION
<br /> S'I'PEI.COMPONENT'l'ROTF:CI-ION, ❑ 1SACRIMCIALANODE(S) 4.IMPRESSED CURRFNT 0 6.ISOLATION
<br /> IX. APPLICANT SIGNATURE
<br /> -
<br /> CER IEICA.T7(TN. I certi th is system' owitafible with the ha7ardous substance stored and that the information provided herein is trite,accurate,
<br /> a n
<br /> --andinfiall a --------- ----------- 470.
<br /> APPLICANT SIC;NAII.JRE DA'FE
<br /> APPLICANT NAME(print) APPLICANT TITL . 471.
<br /> sel -I&Ypro,��
<br /> kver
<br /> Rev.(12/2007)
<br />
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