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UNIFIED PROGRAM CONSOLIDATED FORM <br />UNDERGROUND STORAGE TANK <br />OPERATING PERMIT APPUCATtON - WANK EWORMATtON (ale 1m per <br />OFACTION (CW& one item only. ForItoUSTpo men edomnor>renovA oaa�ide o* abIectfoo aad 1.11.III.(V,and1Xbel m) <br />NEWFft1AIrr 01 RENEWAL FtiRAW 131 CHANGE OF INFORMA` ION <br />f <br />TEMPORARY UST CLOSURE 13 7. UST PERMANENT CLOWRE ON WE 0 S. USI' REMOVAL. <br />DATE UST PERMANENTLY CLOSM. I?ATEWOSTINO UST ESCOVEREUs <br />:L $ACWTVINFORMATION <br />FACtLRY ID 0 (Aso" Uw 0 ) <br />1 <br />BI HAW(smtNAME or DDArDi ft Besinm As) j <br />8US 143 Ci'TY IIH <br />I[_ <br />cli I <br />TAINK QE9CRtFT t <br />TANK ID 0 4M TANK MANUFACTURER TAMC C01'tF10RJumw TNLS TANNR LS 434 <br />b (� cq� DS `KV-,V,`yCG-5AW <br />: �7 <br />DATE UST ALLEI} US <br />TANK CAI' trTAL INNS ill <br />NUMBER OF COtpfARTbIENTS IN THE UNIT 411 <br />UL:TANK=ArmCONTSNTS <br />TANXUSE 19 1& MOTOR VEHICLEFUllM 016, MARINA FUELING 0 Ic,AV1AT10NFVELM <br />3. c'NE5 WAW PROf3 X t MRAGG (3 4. KA AIMUS WASTE Owlsim U -W do CI �. Ef�1GIliiENCY MEF ArOR Fu5111tgC # I�I�It <br />, <br />6, OTHER GENERATOR FUEL 93 93. UNKNOWN E3 99.OTHER Rum <br />CONTENTS PETROLE lLI 0 Ia REGULAR UNL.tEAI)ED� Ic MWORAM UNLSADED D Ib PR> MIUM UNLEADED .a <br />0 3, DIESEL 0 !. IBTFUEL E3 C AVIATION GAS <br />0 IL PETROLEUM BLEND FUEL 0 0 OTHERPETW)LEUM t«ft <br />NOWETRO12LOA! E] 7. USMOL 15 I0. P.THAmm <br />It. OTHER N09Ai PE1 RI,t EIOMc5pedft 44ft <br />IV. TANKGA©crlUllt. <br />TYN OF TAMC I. SINGLE WALL L DOUBLE WALL 9!, t1P11ttiOWlV40 <br />PRIMARY CONfAVQ4ENT Ej 1. STEEL 1 FIB 19S Ej 6* Ri TERN&L BLADDER 444 <br />12 7. STEEL+ INTERNAL L04ING "'UNlWOWN Q 99.OTHER+44 <br />SECONDARY CONTAINMENT Li 1. STEEL FIBMLA,i' S & EXTERIOR MEMBiRANK LINER 7 iwmxETw 44 <br />9b.NONE 93. UNIINOWN 99.OTMM Wu <br />OVERFILL PREVENTION U 1. AUDO" t VISUAL ALARMS U 2. BALL FLOAT 3. FILL TUBE SHUT -OP VALVE Al <br />C) 1 TANK MEETS ENTS MR OCEMPTION FROM mamrREVENTION EQUWNMW <br />V.,PRODUCTIWASTR#00(dwWwRUCTION <br />PIPING CONSTREOCTION L STNGL&WALLED W4LDOUBLI&WALLED 99 on= <br />SYSTEM TYPE -PRESSURE El 2, GRAVTTY In 3, CONVENTIONAL SUCTION In 4. SAFE SUCTION LLJCClt 1317 MI) 4St <br />PRIMARY CONTAINMENT E3 L STEER. PMIRGLASS E R XIB e: 10. RIGID PLASTIC 464 <br />D 90. NONE 93. UNKNOWN 13 99.OTHM <br />SECONDARY CONTAR04M E3 I. STEEL. 4, FIBERGLASS Ll ImExtBLE E3 10.MGRS PLASTIC +1 w <br />0 90. NONE ". UNKI40WN O ".on= iSpoefte *� <br />PIPORYTt2BINBCOWAROCEMSUMPTYPE 19 1. SOX" WALL U I DOUBLE WALL E3 90. NONE 4e.Rt <br />VL VENT, VAPOR ANO °/ M L PlPWG lt�Lp,mIRUCrm <br />VENT MUMMY CONTAINMENT E3 I. STEEL FIBERGLASS EJ 10. RIGID PLASTIC E3 90. NONE E3 99.07HER ISperi" <br />IM <br />VENT SECONDARY CONTAINME7NT E3 1. STEEL E3 4. FOERGLASS L3 10. REOID PLASTIC FWNONE E3 MOTHER OPPW <br />a4 <br />VR PRIMIIRYCONTAPOWWT E3 L STEEL W. FWERGLASS 0 10, RIGID PLASTIC E3 90. NONE E3 99.OTHER (Sp-lV) M# <br />Mgt <br />VR SECONDARY CONTAR04 NT 13 I. STEEL 0 4, FinaGLAS3 Ll t0. RIGID PLASTIC 90. NONE E3 99, O TIER ISPn[W <br />t <br />VENT "PING TRAIN3TTION SUMP TYPE 1. SRNCR.E 13 2.22M WALL IQW NOrQi <br />RISE1 PRIMARY CONTARNIMM STEEL FIBERGLASS4. FRGLASS 10. RR3AI PLASTI90. NOl1$C 99, OTHER ISI+ow) <br />I <br />0 4. FIBEROLAS4 EJ I% RQW PLASTIC VWNDW U 99.. UTTER ( ) <br />4641 <br />n INSTALl" sh . SP'1tl BUCKFi1 STRIIFA PtATw8OR`T�O�MaimiaciaCTlm 4. CONTAINMENT Shit? #iw <br />CONSTRUCTI ON WLSINGLEWALL O X DOUBLI WAIL C3 3 No DWENSERS Q 40. NONE ail► <br />CONSTRUCTION MATERIAL t, s TEFY OIL RIGID PLAST3C 4t.OTNER <br />s <br />C RiTlEl1'lOy„ <br />STEEL COMPONENT PRGIECTTtiN 13 2. SACK WICIAL ANOMM O 0. IMPRESSED CURRENT 6.130LATION <br />CMM If CATML1Ms I eam* dm dit W e+371dti Y e�Ripi1lie *M do hame dWo IdeAmpi Rleleeel mel dM &o ieie�r>treWea � is trw. <br />ae♦i lei Eeif rr1tY <br />PL CANT SIONAIURE 19DA7 <br />C , <br />Iq <br />APPIJCAtiT Nl1ME (prior)h <br />4071 <br />AIPLICANT CC! ILe .- r. <br />S <br />r <br />a <br />Lbw. (li/Z�7) <br />