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imi WM PROGRAM COPMOU DATED FORM <br />E. UNDERGROUND STORAGE TANK <br />OPERATMG PERMIT APPLICATION - TANK H ORMATION ale rmmva u I <br />TYPE OF ACtIONI (Cbeickowilmomly. Farm LST pammml clome armmmidmopme mly olbawfim wd Smdom Ia IL UL (V. and IX <br />L NEW PERMIT Cl 3. RENEWAL PERMIT S. CHANGE OF INFORMATION <br />0. TEMPORARY LIST CLOSURE: 0 7. UST PERMANENT CLOSURE: ON SITE S. USC REMOVAL <br />DATE UST PERMANENTLYCLDSEV: DATE DaSTING UST DISCOVERED: AW <br />L.;FACUMMORMA <br />FACMrCY TO 9 (Agmgw Um allh) It <br />WJS (Same R NAME or UBA D*4 As) <br />t�CA <br />S[1SlTE <br />CITY - <br />,"" AMMMU ION <br />TAN/K� ID 0 <br />TANK MANUFACTURER <br />TAMC ctR�'FIGURATRIN: THIS TANK B 4% <br />I� �y <br />�� V 19 V / <br />❑ I. A STAND-ALONE coewr A TANK <br />❑ z DNB IN A oaaarARssENI>?aa ural. <br />DATE UST ALLED <br />T ALLDNS 4m <br />NUMBER OF CqrRTMEN7S IN THE UNIT 437 <br />CONMN'I'S <br />TANK USE a MOTOR VEHICLE FLTLING Q lb, MAMA FUELM Cl 1a AVIATION FUELING � <br />. CHEMICAL PRODUCT STORAGE (3 4. HAZARDOUS WASTE rhdm + umdoi r Cl S. EA iE? C'Y TOR nrEL IUSC mn1-$(OI <br />E3 4.OTHEROENERATOR FUEL Q 93.11N W400" O 90. OTHEIE �19s <br />CONTENTS PETROLEUM: I& RUGULAX, UNLEAM Q le. MIDGRADE UICLEEADW [3 Ile PRII IUM UNLEADED 440 <br />3. DIFSE1. 0 S. lff Fuel I3 & AVIATION GAS <br />3. FES MLEUM BLEND FUEL ij 9.OTIM PETROLEUM 4ft <br />NOXmEKiM:EJ 7. USED OIL U I0. ETHANOL <br />11.OMER SUM 44% <br />IV. TAM CONSIVOCTI.' <br />TYPE OF TAMC1. SOHGLS WALL Mat DOUBLE WALL E3 9!. UmtNOWN NI <br />PRIMARY CONT L STEEL lQ3.FIBERGL.ASS C3 & INTERNAL BLADDER <br />7. STEEL • INTER LINING 0 95. UNKNOWN 0 94.OTIIFR 44k <br />SECONWAYCONTAINMENt 1. STEEL M.%FMERGLASS L3it IUMMOR MUORANE L.1NER Ej 7. IACR 6TED 40 <br />OLNONE UNKNOWN Q99.OTIMRR. 406 <br />OVERFILL PREVENTION I. AUD®LE A VISUAL ALARMS U L BALL. FLOAT . "TUBS SHUT-OFF VALVE 4!2 <br />El4. TANK MEETS REWMEMENM FOR @KEMIMON FROM OVEXJrMEVENTM PMENT <br />V. PIIS OWT I W COINS lRUCTION <br />rum marO SIRUCTION 1.SINGlE-WALL>:D 5K DGUBL.E-WALLED 0 90 OTHER <br />SYSTEM TYPE PRESSURE 2. GRAVITY 3. CONVENTR)NAL SUCTION 4. SAFE su TION 2! ccR ) aPl <br />PRIMARY CONTAINMENT 1. STEEL FIBF]IOLASS a_ FL.FXIBLE I0. RIGID ELASTIC <br />Q 90.NON9 95 UNKNOWN 99. +� <br />SEOONDARY CONTAINMENT 1.57am !. P 1533 >4 FLE7±IHLE 10, RK3>D PLASTIC <br />90.NoNza 93, 99.OTHER 46ft <br />�T? COMAUV(ENT SU1NP TYP1? SENO OMWALL L DOUBLE WALL 90, NOME <br />VL VXNT V� . AND RISER I FILL PIPE PIPING CONSTRUCTION <br />VENT PRIMARY C(WAINMENT 13 I. STEEL 4. FIBEROL.AM E3 I0. RIGID F=UM t3 90. NOW El 99. Q iii <br />X641 <br />VENT SECONDARY CONTAINMENT E S'TE 4. Fmm LAss 10. RLGm l7 JSSTIC Nth El 99. t TILER(5pm;Wy) <br />MMI <br />VR PRIMARY CONTAINMENT I. STm- 4. FIBERGLASS 0 10. RIGID PLASTIC EJ 9m NONE 13 99.O HER ) <br />VR SECONDARY CONTALNMENT I. STEEL L3 4. FMEROLA.SS 0 i0. RIGID IPLASTIIIC NON1 Q 94.OTHER OpW*) <br />VENT PIPING TRANSITION SUMP TYPE 1. SV;GLR SPALL 0 1 DOUBLES WALL MANOME <br />RISER PRIMARY CONTAV44ENIT FIBERGLASS LJ 10, RIGID PLASTIC M 90. NONE E3 99. OTHER ISpae*) 4N� <br />JWLSTEVI.C <br />RISER SECONDARY CONTA04MENT Ll L STEEL E3 4. F0WJtOLASS 0 10. RIGID PLASTIC E3 90. NONE E3 99. OTHER Opaedy) 4 <br />FI.L INSTALLED ad. 314LL BUCKET Q 3. STRIKER PLA 4, CONTAINMENT SUMP 451+o <br />VO. UNDERE� �"A�1` <br />CONSTRUCTION r PII 11,11. SINE= WALL L DOUBLE WALL 0 3. NO DISM4111113 0 90. NONE 46% <br />CONSTRUCTION MATERIAL I. STEIL tlx RIGID nASTIC E3 9R OTHER tspedw <br />STEEL PROT9CnON o L SACRIFICIAL ANODEM ❑ 4. IMPRESSM CURRENT o b ISOLATION Er . _ _ 4-K <br />TWK. 14wl* OW *b USF 31 M =ogmd 11e wMl da mobft oa I I i aM *A LYt IRferrRM4aB poo 111ad M LIMO. utwok <br />r <br />and 4 AIB rrilR <br />APPLICANT SIGNATURE <br />� <br />t <br />�� 11 t � t 2,^ <br />E+ <br />APPLICANTAMXANT <br />NAME (pft) <br />TAE 47L <br />tmcv UST -B - Ill IfrNt. (>L2J38071 <br />