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UNIFIED PROGRAM CONSOLIDATED FORK. �` TANKS 0 UNDERGROUND STORAGE TANKS-TANK PAGE 1 (two pages pe t Page _ of _ TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4.AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ T.TEMPORARY ERMANENY SITE E CLOSOSED R SITE (Check one dem only) 10 /, RENEWAL PERMIT (5 �,mason•1,local use only) (Specify change•lorlocal use only) ❑ 8. TANK REMOVED 430 t BUSINESS NAME(Same as FACILITY NAME Or DBA•Doing Business As) FACILITY 10 F F/C Al/x/ C7 LOCATION WITHIN SITE(Opdonaq 431 1.TANK DESCRIPTION TANK 1074 TANK MANUFACTURER COMPARTMENTALIZED TANK �Ye4 C1 No (/�^ � � �� If•Yas',complete one page for each compartment. RjN-J d-7E 45 NUMBER OF COMPARTMENTS DATE INSTALLED(YEAR/MO) TANK CAPACITY IN GALLONS ADDITIONAL DESCRIPTION(For local use OWY) 11.TANK CONTENTS �. TANK USE 432 PETROLEUM TYPE ❑ 5 JET FUEL 1. MOTOR VEHICLE FUEL ❑ta. REGULAR UNLEADED 2. LEADED @I,,- 11 (if marked.complete Petroleum Type) ❑Its. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM arl"c'MIDGRAOE UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAM (from Hazardous Materials Imanto a ry Page) CAS a(from Hazardous Materials Inventory page) E ❑ 4. HAZARDOUS WASTE(includes Used Od) 95 UNKNOM- 111.TANK CONSTRUCTION rTANK ANK ❑ L SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM [JJ EXTERIOR MEMBRANE LINER ❑95. UNKNOWN item only) 2. DOUBLE WALL ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER ERIAL.primary tank ❑ 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN ❑ 1. BARE STEEL � (Check one dm �-I eonly) ❑ 2. STAINLESS STEEL per+. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE W11C0%METHANOL ❑99. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL•secondary tank ❑ i BARE STEEL 0 3. FIBERGLASS/PLASTIC C18. FRP COMPATIBLE W/100%METHANOL ❑95. UNKNOWN 4. STEEL CLAD WIFIBERGIASS ❑ 9. FRP NON•CORROOIBLE JACKET ❑99. OTHER (Check one dam only) ❑ 2. STAINLESS STEEL REINFORCED PLASTIC(FRP) ❑10 COATED STEEL ❑ 5. CONCRETE OATEINSTALLEO TANK INTERIOR LINING [:11. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 OR COATING ❑ 6 UNLINED ❑99. OTHER ❑ 2.ALKYD LINING ❑ 4. PHENOLIC LINING (Forlocal use onl) (Check one demo ) DATE INSTALLED OTHER CORROSION ❑ 1,MANUFACTURED CATHODIC 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 PROTECTION IF APPLICABLE PROTECTION ❑99. OTHER ❑ 4. IMPRESSED CURRENT (Forloca (Check one dem only) ❑ 2. SACRIFICIAL ANODE QJ YEAR INSTALLED TYPE(For local use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED [ / SPILL AND OVERFILL � ,..,/ 7 (Check as that apply) ❑ 1. SPILL CONTAINMENT 1K 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE ❑ 2. DROP TUBE - ❑ 2. BALL FLOAT ❑ 4. EXEMPT. ------------- ❑ 3. STRIKER PLATE N.TANK 779 T WALL TANK OR TANK WITH BLADDER(Check one item On!d' IF SINGLE WALL TANK Check ap fAa!a ): ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MUAL(SINGLE WALL IN VAULT ONLY) . ❑ 2, AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE NTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUSATG ❑ T. GROUNDWATER NUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ 6. TANK TESTING BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? ESTIMATED DATE LAST USED(YR/MO/DAY) gallons ❑Yes ❑No Formerly SwRCS Fc CUPAFORM(4/99)