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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGET S-TANK PAGE I <br /> Poll. at <br /> TYPE OF ACTION 0 1.NEW SITE PERMIT 0 4. AMENDED PERMIT 0 S.c"AmrE of iwomumiom 0 G. TEMPORARY Slee`CLOSURE <br /> (chftk one item Only) 1 PIENE14VAIL PERMIT 0 7 PERIIIIA"IENTLYCLOSED ON SITE <br /> (spsc,yy maso')-r"tm.t -10 (Spec.4-ftog. Of& TANK REMOVED 43o <br /> BUSINESS NAME(Sam.a.FACILITY NAME w DBA-00ing B-ifte..A.1 FACkITY 16-1 -T-T <br /> Vo_ck <br /> LOCATION WITHIN SITE j0phonsp 431 <br /> $1 MNK MANUFACTURER 1.TANK DIESCRIP'11ON <br /> TANK 10 <br /> COMPART"LIXED TANK V.. <br /> A^ tf-'res-,cafriviom one patio for each <br /> OAT4 INSTALLED IEA TANK CAPACITY IN GALLONS kUMOLR OF COMPARTMENTS <br /> ADDITIONAL OESCATPtION fF-I-A)tNtm Onm <br /> (I.TANK CONTENTS <br /> TANK USE 4ti PETROLEUM TYPE <br /> Plkj. MOTOR VEHICLE FULL Ia.REGULAR UNLEADED 0 T. LEADED C1 5, JET FUEL <br /> ;r6ad,camplafo,pefmr-�Type) Lb.PREMIUM UNLFiADFD 0 3. Diesel, 0 S.AVIATION FUEL <br /> . NON-FUELPFTROLEUM ®117.MIDGRADFUNI.F.AOF-D ® 4. GASOHOL 13 99, OTef_R <br /> 3-CHEMICAL PRODUCT <br /> E3 4. HAZARDOUS WASTE Ifedoda, COMMON NAME(Imm NandellNol Afardsiali ratmieturyMe) CAS 0(FMM 141AA10.5 mplonels forrvoefoly papep <br /> Used 007 <br /> Lit.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ <br /> 1. SINGLE WALL 0 S. SINGLE WALL WITH Q S. SINGLE WALL WITH INTERNAL IXAODER SYSTEIL, <br /> (check-Ite 001"e w 2. (IOU 0 L C WALL EXTERIOR MEMORANE LINER 0 gs UNKNOWN <br /> r1% 04, SINGLE WALL IN A VAULT 0 99 OTIIUR <br /> TANK MATERIAL-Priclivy lank *-f 1. <br /> Al- BARE STEEL 03 FIBErIGIAISS(PLASTIC 0 %.CONCRETE 0 OS LAN14NOWN <br /> (CruIC&a-ir.m ve)y) ❑ 2. STAINLESS STEEL 04, STEEL GLAD WFIBERGLASS 06.fiLP COMPATIOLF WIW0%METRANO1. 0 9%.OTPIER <br /> - FIE)NrOrTr_ED PLASTIC(FAP) <br /> TANK MATERIAL-secondwy Lrk 0 1, BARE,SIECL D 3.rKIFRGI ASS I PLASTIC 04 FRP COMPATIOLE W1I00%MCTHANOL El 95 LINKNOVVY! <br /> (C Pleck one dom OnI)l ❑ 2, STAINLEt'5 STEEL 04. SiFIEL rkADWIFIDERGLAss 09, PAPNON-rOAR004111LE JACKIFT PIQ99 OT"ER <br /> REINFORCER PLASTIC(FRP) <br /> 11 TO COATED STEEL 1 nmeA+ <br /> CJS CONE RETF- <br /> TANK INTERIOR LININ45UA FF INSTALLED <br /> OR COATING ❑ 1. RUBBER UNED El .1 EPDXY LINING 0 5.CLASS LINDNG ®9S. UNI(NOVV"433 <br /> ❑ Z. ALAYI)LINIING 4. If*AKx.w,LINING MING A, UNIT loco 0 W),OTtIER <br /> -froftct,one itant,oMyp <br /> OTHER CORROSION 0 T. MAIAJFACTURFO CATHODIC Q J. FI9ERGI_A-SRCfI4FORCU-0PLASTIC 0 W, UNKNOWN 434 DATE IIN%TALLE0 <br /> PROTECTION IF APPLICABLE PROTECTION 0 4, IMPRFSSEDCLIRRENT ®89. opwR <br /> f0mck Ono Item dray) 2 SACRIFICIAL ANODE 1017-1 1110 1311-Y) <br /> SPILL AND OVERFILL YEAR' - <br /> INSTALLED TNPE(Feld?-*J-v w4y) OVERFILL PROTECT ION FQUIVMENT YFAR INSTALLED <br /> (Uhecx as that&Ppfv) IV <br /> I CONTAINMENT 1AL TUFJ; SP/UT Off VALVE <br /> SPILL MINTAI . ALARM ❑ 3� FIL <br /> 2. <br /> DROP TIME AN 2, IMLI_F;L0AI 4 CXrMPI <br /> PLATE <br /> WJANK LEAK DETECTION, <br /> IF SINGLEWALLIF DOUBLE WALL <br /> C3 1. VrUAL(E:rPoscDPORTI;N ONLY) • S. MA140JAL TANK(;AUGWr,(mrGI CI 1. VISUAL(SINGLE WALL Iti VAULT ONLY) <br /> 7Lj CLJfJ tl!NUUU�INI Lit Z�it$IAL PA01,11 I L441TX, <br /> Z, AUT(.)MAYIC TANK GAU&NC,(AT(,) 6 /OuL <br /> 3, COaTTINUOUSAIG U T. GROUNOWATER ❑ 3. MANUAL MOMTORINK; <br /> 0 4- STATISTICAL INVENTORY RECONCILIATION(SIR)• 0 0. TANK TESTING <br /> CLEMAIA11,TANK TESTING 09%. O-ItlEft <br /> V.TANK CLOSURE INFORMATION?PERMANENT Cl OSLIXE IN PLACE <br /> ESTIMATED DATE EAST UIEO(Y1.01MIl 6 STIMATED GLIA141.1TV Or 5149SIANCIi AEMAWW, 435 TANK FI'IE0"7-?!1"EFt7 MATI�R!AE? <br /> D vu- 0 Pla <br />