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UNIFYLD PIIAGXA A CONSOLIDATED FORM
<br /> UNDERGROUND STORAGE TAMC
<br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(Ono Porm por li9T')
<br /> TYPI!OF ACTION (Olwk ono ivim only, For m UST pormotlork clonus or romova(,complote only this swigs and swlont 1,11,111,IV,4n4 rX DO!ow) as
<br /> ❑ I.NI:%PtiltMrl' ® 3.ft5NVWAL P9RNITT C3 5.CHANGE OF INFORMATION
<br /> _6.wiMPORARY tit3T CIASLIRk 7.UST PERMriNf,%TCi OSURL'ON SITE 0 8,Wt RUMOVAL
<br /> ()ATE:US'1•PFRMANEN 11Y Cl.ASLD'. :)AM A XIVr!N0 UST DISCOVERED! �Jo�
<br /> 1. FAC,HATY INFORMATION
<br /> raclLrrS tU a(.t n,icv Um ali.i 0 0 �i - {�
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<br /> HU5IAIBS5 NAME(5aae tw FACILITY NAME or CBA-Doig`IBlroltteee As) {
<br /> BVSINI:SS 5rfh:ADDRCSS FQ Cum -�
<br /> IL T.OK D6gCRJPTION
<br /> TANK a)q +S2 T KCONFIL7UIlA9'ION:'TH1S'I'AWK ty rse
<br /> 1.A 6A COMPIi TANK
<br /> NI?IN A COMPAaTMPJJ'rE0 UM1q•.
<br /> I
<br /> DArg1:51' Y RMI +115TANKC..APACT I. I
<br /> " NI)M81?RfFC0MPAR'TME%rrawitw'UNIT 't17
<br /> 111.TANk USE AND C()iti'FENTS
<br /> TANK USE? a.MdTOR Y1 HIGT 1?r UJEt•tN0 Ib,MARINA FUfLJNG U Ic,AVIATION FURLING
<br /> ❑3.CHIMICALPRoDuclr romol: •i,HAZARDOUS WAS'rHprd,drttwcA4 ❑ 3.t{MEiRGR)JCYGGNIt1tA1'OA1Ult:.(itlCOlSlgt.;(e13
<br /> 13 6.OTHER GENERATOR fum 95.UNKNOWN TKR
<br /> CONTENTS PHTAOLBUM: o.{t8oul.AR INLBADED IcMIDORADIONLEADRO I9M {Y
<br /> UNIXADBD _
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<br /> ��--IJaN-Prf Rp(tilii( 7.(SEA(>U. i0,fTJJAN01,
<br /> 0 11,OTN6R NON'-PMOL411ML$ua M: F101
<br /> _ I V. TANK CONSTRUCTION
<br /> TYPC OF TANK 1,SINOLF~VALE .DOUDLI WALL as.u'4KNDwN
<br /> PPJMAKY CONrA!NIV10T 11 9'(L•l )•'JOERi7lJl5S 6.INTERNAL MADDER --- 44.
<br /> ❑7.S;Zl..i rYrtXNNL UNING r-) Jj,UNKNOWN 99,0TNHIi 189W&Y 44 A
<br /> j SBCONDARV t UY!AtNMRM" 1,III=. C18!UR04ASS f J 6.FaJCSI1RlOR mama ANO ldN&R 7,JACKETED ~�
<br /> 90 NOAiI+ 9S.UNKNOW!V ti9.t17Ni?R S(,peai Na^
<br /> OV99F'LLPRLVAM10N I.AUDIHLH8VAIIJALALARMS 2.BALI FLOAT i Ai
<br /> �4,TANK mrxis Yw, lKliAtENTS FOR cmamPTION FROM MCKPILL PREVENTION OQUIPMHNT
<br /> -- V. PRODUCT I_WA,STE PIPING CONSTRUCTION
<br /> PEP)NGCONSTRUCTION �f I.SJNOL[3•WAI.LIID 2.DOURL.L'-WAI_LE?D 99,t71'HL'K 440
<br /> SY3(1iM 7Y1'ti i.PRMSURit 2.ORAvrrY !,CONvB*Yr)ONAL SUC YIOP' e.SAfit si1C rtON 2l cCa 4a6MLaRJH 4se
<br /> PRlMARYCONTAINMf•.NT LI 1 SiTIM. tW 4.rWERGLAS5 Q 8,PLUVOLL El 10.RIGID PLASTIC 14'.
<br /> 98,1JONfi
<br /> Ll 95.UNKNOWN ❑99.OTJEkR 44.13
<br /> 5HtY4NDnl(Y CONIAIN01t"NI T I.STE19 a.FUffiROLASS 8,FLERIBI_E 0 30,RIGID PLASTIC 4544
<br /> 90_NONE_ 93.UNKNOWN 13 99.0't'HER 46w
<br /> +'1PINGiI'URI)WE,CON'TAINNWNTSUMP l'YP)-, Q 1.SINOLTi T 4d.NUN@ 04a
<br /> VI.VENT,VAPOR RECOVERY(VR)AND fUSBR I FILL PIPE PIPING CONSTRUCTION
<br /> VL't+'C NUMAAY CONTAENMBN'f 0 1.57 a. ii4FR LA59 f 0.RJ0lD t+LA"rR' Pa.NONE cl 9%5;i{$P. -co
<br /> 4610
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<br /> VR PRIMARY CONTAINMBN(' -�1.9YTsri, (.i IH6AOLASS 0 to.R!G)U PLASTIC 0.NONtl 0-".OTHBR(Speciry) - '4,(Art
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<br /> VR SECONDARY CONrAINMENT 1,S7li6I• 4.PIAMOLASS 0 10.RIOID PLASTIC 90 NONE 0 99.MER(SON*)
<br /> v$N'ri'tPtNOTRANStT10NSUNlSUNT''CYl'E rl 1.9JN IBWl.L DOUHLIEWALL NONE 7M.RISiR.MIMARY TAMME:n, 1.$7'EEr'S. s.P10IiKO1A85 l i9Ml-QDPLASTIt 0 90.NONE El 99.OTHQR(SOeelly)
<br /> � e I
<br /> I R'u9l R$LC4Nt KY CONTAiNMF:I:7 I.STEEL 4.FIBERGLASS 10.P-4-MU97 E3 90,NONE cl 90,urmemsp-my) enh
<br /> MI.(-0MVr i+f ZtS INSTALLED ba.8141,•SUC tri u 3 STRixim PLATI'yoonom PRO'rmc-MR 1 4.CONTAINMgm,svmt 4-4p
<br /> V11.UNDER DISPENSER CONTAINMENT UDC
<br /> Ct)NSTAUCI'ION TYP4691
<br /> E
<br /> rclo�'sTAUCt . WALI 290.NON
<br /> oIONNATAIAL i1TL .141GIDMA37f
<br /> o9.OrFIrn o
<br /> V Y. CORROSION PROTECTION
<br /> $'FHP,(.COYIONl'NTPAOTfsCtiON ❑ 2.SACRIFICIALANOD8(S) ❑4.IMPKRS$ISACt)RRBNT 6.isuRrim 4A
<br /> M APPLICANT SIGNATURE
<br /> CEIYFIFICA f(0N-I owdly tial th(s UST es'slom Is eml patibke wide the ha4ardoR9 n6lfteAOe stand and that tiw 1n0irm u"pmidsd kcrek+14 rrse,e¢aurat'e,
<br /> anti In full ae!{I Hence with 1 al r AIRAl44
<br /> AP 10C:AM'SIGNATURE DATE
<br /> APPLIC'ANTNAMI:;Orfn!) tQf (�� ,`�p APPI,ICAME'7'ITLI(
<br /> t1PCl'LU'I'_l3•U2 Rc..(t2rsaa7)
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<br /> L50/600&3 OUR DPS C£6€89l66Z XKJ 117-'S7 681 6002/61/ZT
<br /> LO 39VJ 0 T1N00A InVcA 6901666602 5Z:b0 660Z/0T/ZT
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