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a <br /> UNIFIED PROGRAM CON$OLIDATP-D FORM <br /> UNDERGROUND STORAGE:TANK <br /> OPERATING PERMIT APPLICATION--TANK INFORMATION(One tbrm per L:31') <br /> 'TYPE:0F AC-1110N X'! k ono iWm only. For an IJS'('p-main l c(osure or romovel,complow onty mk soman and Sections 1,IL III,!t',r nd IX ooww) 4.13 <br /> a i.NfiW ftRMri (p' ,.RENt'WAL PERMIT C] i,Cl[ANOU uF 1NFORNIKNON <br /> D �.'1TiaPOR nRY I:S'I'CtgSlit S 7.UST Pri1tMANL\T CI.OSURF ON SITE. u,U5T REMOVAL _ <br /> DATE.U$7'PERMANEN I'LY I:I AS6U atell 'ATE F)�15'1':NG liS'l'DtSCOVCItGO: <br /> I, FACILITY INFORNIATU)N <br /> fAC'IL171'710 9(.:go.,;c,'vsa(J h) <br /> I Hl41NE'S5 NAME(5atm+oa f:�Cli•irY hnMF or GL3A.noinQ(3'Isiltcroas ns) -r � <br /> t3UStIiCS53r[FADDRESS �� �• <br /> V1 J W. Y CrfY - to <br /> 1I,TANK DE25CRIPTION , <br /> TANK ID - 'TANK MANUFACTURER 413 TANK C:ONFIG ami,{ON Tlfrs':'ANK Ib - �- 134 <br /> ASTAND-Ar ONE TANK <br /> ONE.IN n C ARrAWWrcu <br /> t.aR aw an Aa.0 fov cmh calf nok-ol to:7V u,il <br /> D.tfEISY 'I'R I; \i 1,T:1) '15 I;VJ C ,q(:tr,YiD1 ;ALI.f1MR °� MilwalN OMPARTMF.N'rStr,gji'UNI'fail t <br /> III,TANK USE AND CONTXNTS <br /> TANK Uf:id a.momt vVdICLL;1'UiY.IVD 0 ib.atAXlNA FLL,LrlqC 1c.A%'In'..'tON Fi;M.NO -134 ' <br /> ❑)•CJIEMSCALORMILXTSTORAOR G".;IAxAHDGUSWASIT(f.d,d.Uwaap C]S.tiM¢Rt7P.NCYOliN1!kn?ORr'4i:;.pMC32]tS:.steq <br /> 0 05,UNKNOWNOTHER(sheet,Y 04 <br /> )h'T <br /> C( LN'15 PUA0LkUM: 13 Sa.tGq(:P ial".:�!L&1D¢D ❑ Is,HID!1Rr10E L'VI CADIIb A.PREMIUM L NLEAI)BB <br /> 03.DffiS!!' Q l. I.IPT i'Ur:L ©6.A Y)A T 1011 CA$ <br /> ©8.PR'PROLisUM SI bWD dUlL. ❑9,Ol'11ER 1'G2Rt1LL'aAl --_-- ($OccEIt1; a+o <br /> NONTErROLliUltr;Lj 7.LSEDOn. Ifl.iTi(nNOt. .I <br /> � 1 f.O'rHCR NnN-pisi'ROL'aUM Su:ei!�: ir)p <br /> IV. 'TANK CONSTRUCTION <br /> 1 NAG aF TMTK _ ❑ 1.S(NGLE WALL .DOUBLE WALL 03.UNKNOWN aa, <br /> j PxIIY'ARYCO Tw:NIMr;wl' 0 I,STEEL 3.t'WERGLASs M4,tNf¢RNnLU1.nOra(R 1 <br /> ❑ ySTEEL,.NTERNAL tWIN(i IS. MKN0WN ❑WIDW£tt_ Specl Pf): I:we <br /> StFO DARY r�YI+UNSnrN "�,3TUL ,FIQEROLA33 0,fi C2=RlOk NF►aUkANB LINER~� Y,JACK11T¢D �a <br /> h0:4DN{ hi.tivKyOWV 0,C-71hiR <br /> OVP.Rr':LLrRfli'I(NPIM' 1.00111LB A VLSUALYILARM6 2.11atl•FLOAT ILL"Ort•M47JTQFF VALVII <br /> �]4.TANK MEETS;I!SUIREMl:N1'5 FOR C ZdMVJ'JUN FROM OYCItI' .L ItIt1iVEN'PIGN Ex Utt is i <br /> - <br /> V. PRODUCT I WASTE PIPING CONSTRUCTION <br /> IPT cco�151TtbcT:or: �i:s'irJcif wALAEIS 170UDt1.ivAitY?D 90.01FIQIi <br /> nYb-rfM'rYPI' 1.PR[+fisUltli 3,GRAV �i�I S.CONYIyN'f(ONAL SUGT(01� a,3+1t:L'51]C:'r10N(t]CCtt$-p3d1ra,11t t3e I <br /> '[tit lnrtr CONiAINI}(tIN'•' 152 CrsL -�(�Lo,*42H.,EH'SS I.FLURIDLL• -U 0.RIU,D PLASVC. o <br /> ❑hJ.NONE 97.L NKNQWN ❑M/.OTt�R( belfyl: k.,, , <br /> ti:??ND IRY CON fAU\i tFNl" l.STE RL +.I'N1f:Itu A65 b RLE YIBL¢ IO.Rr(I{p Yi,ng7:C +,+4 <br /> Ll <br /> 11 NONE Q a+.UNK';pwN ❑90.OTi(ER S roily) yt <br /> (AfnGlPt�KUIN¢COYrAINPAi:N"1"aLMPTYPY 9(NGLt:WALL z.b6U9LclWALL {)O.ZAK +5y <br /> VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> "Rli ARt'C0N l%iNMiiNt' El 1ST" %Z4.66169CILASS 0 IQ.RIUIDI+LA.�T(C O0.NON(i c 99. "Pflf;4,(ypusiiy' Sdi <br /> wVfNTBIpNDRRYCUWIA:NM ;i j.S7'LLL 4,FlEF.kCLn IO.hlGIL1I+L�1 "I'K N()NN . 1'MER( ruuuy; ytt <br /> Lk PRIMARY CONI'Arx> a'irl <br /> LENT I.STEEL. a,'Irtfia t,ASS 10,R)O1D Pl t$7 l0; Iv¢' 99.6THER NO-11 it +s+e <br /> vliSfiCONDAAY CONTAINMENT I <br /> 1.STIIP,L a.F:QIIRGLAdS I0.k10tt)Pt,ASTK' sTO.NONB 9u.7rl•1@R(SpepiiYl �bn. <br /> I RyE(gAftr P141`1141141`11413wRTvRnCpNTn1NMCJT vlf15LiI.EWA + :.DGBLL WA N NAi <br /> 1rIQiRAdtS O,RrofOPASTK 90. QN9vM1 <br /> 9g.DPH4R(SpmrJJfyl -- <br /> 1 <br /> 1 Jt S• 9IIC0ND ARY 73NTAIN"IF:Ni I.52"GEL MF W(GLABS Ll !0.91GIDI-CANIc <br /> E3 00.NONE E3 90.mrst-(*WeJ dr k <br /> rlt•L CCMPpNENT3IN&'in4LLD a6aRf <br /> I.Srtl.L fSUCKIfI' 3 ST IKRR PLA'rfJ OM PR07'ECtGR CON 1 AIhMIiN2'9U1t1' +.1+K <br /> VIi.UNM DISPENSI4R CONTAINMENT VDC) <br /> c:0\'f'fkrJC t'tON TYPE 1.SINC(LF w AJgt aNJI$t E WALL S.N10(]ISPEI�L>RS 90.NOvI <br /> C?>\'g'r>itJCT(ON MAT'LItInL 1.5TEEL a.r1U¢RGLASS 10.WOUI PI AS-ric. 99.()171tR S i <br /> VIII. CORROSION PROTECTION <br /> S'C¢¢LCO•NPgNtiNTPltOTIiCt1oN !_J 2.$ACRIFIC(ALRNODO) ❑4.IMPRIAMCL' SOLA'rION a.st. <br /> _ IX, APPLICA,N T SIG NATURE <br /> CEJ('f'iFtCA t'tON=i1 uerilfy dlat tkbl UST"Kom k corgatYlle with tko pnan>rdogw rubra ace atorrd and link the hlbnt tlotl provided Ilerekl k true,+oeurllt, <br /> �t�d 1n flIi1 iaaoo wkb low Nlrcmats. <br /> APPLICAMi SIGNAT„IiS DAM y 07 IrJ. <br /> nPl'f 1CAN'I'NANit!ilKincl A L APP11CAKI'Tint t! l / ��• L <br /> IS,01 <br /> UPC t'UST is•lr2 a <br /> (I2RO07f <br /> coaisooQ <br /> qH8 �t'S EED£99odOL Xttai BTtSi fIH.L 6002/OT:�i <br /> 90 39Vd 0 T1N00A invd 690TEEE60Z 5Z:b0 EEOZ/0T/ZT <br />