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.� , <br /> UNIFIED PROGRAM CONSOLIDATED FORM `2 <br /> TAKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> asGe if <br /> ^(PE CF AC7:CN <br /> G'+eca one.um anry) NE`N SITE?ERMIT ❑ • ANENCEO PE4NIT ❑ S. :HANGc CF INFCAMAICNI <br /> 7 'E.MPC P?R'!SiTfl CLCSUA: <br /> I� ?. PERMANCN,'!G:SEC CN 51 <br /> _.3.RENEWAL 2E2M17 ;5..'N meson-.'w,oear uae wy) ISaeody clew-tw total use oruYl t 1. TANK REMCv_0 ala <br /> 3USINESS NAME;Same as FAC:UTY NAME or CSA-COep 3use+ess A+I FAC:UTY:0 At - I IT I . <br /> LCUTION WITHIN SITE(Cpaarw) �1 <br /> I <br /> 1.TANK DESCRIPTION �/ <br /> iANK MA ACTU(l� CCMPAATMENTAUZ£0 TANK fry.. <br /> ❑ No <br /> -ANK 10 a I <br /> If Yei.�nMete one:agra hx aaat c.m0art•:ent � <br /> NUMBER CF COMPARTMENTS <br /> DATE INS TALL=0(YEARIMO) TANK CAPACITY IN GALLONS <br /> AO/D L DESCRIPTION(FOfW-30 use oNy) <br /> I <br /> IL TANK CONTENTS <br /> TANK USE 432 PETROLEUM TVP£ <br /> t. MOTCR VEHICLE FUEL <br /> ❑Ia. REGULAR UNLEADED- ❑ 2. LEADED ❑ 5. JET FUEL <br /> (ff marked.-0,001-10 P-tm--m 1"YPa) a PgcMIUM UN1�4.10ED ❑ 3. OIESEL ( ❑ & AVIA-,ICN FUEL I <br /> ❑ 2. NON-FUEL PETROLEUM ❑to MIOGRAOE UNLEAOEO ❑ 4. GASOHOL Cl 99. OTHER <br /> ❑ 3. CHEMICAL PROCUCTCAS a(from Naza=us.Mete"/s if eamry page) <br /> COMMON NAME(hem NazarEwrs Ma/enLs Imenrory page) <br /> ❑ a. HAZARCOUS WASTE(lOctwes <br /> Used CA 1 <br /> a I KN <br /> 111.TANK CONSTRUCTION <br /> TYPE OF-ANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL'MTH INT`RNAI 4UOCE+i SYSTEM iiIf}f <br /> �/ EXTERIOR MEMBRANE UNER 0 95. UNKNOWN I <br /> (CJ•.- -a0 dem onry) rr 2. OCUBLE'.vALL <br /> ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER <br /> ® t. BARE STc- <br /> TANK MATERIAL-PnmarY tarot -r ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑45. UNKNOWN <br /> (Check an-dem oMy) ❑ L STAINLESS STEEL ❑4. STEEL C-AO WMSERGLASS ❑ S. FRP COMPATIBLE`I100%METHANOL ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL•s-w-darY=11 ❑ t BARE STEEL. ❑ 3. FIBERGLASS I PLASTIC ❑ 9. FRP COMPATIBLE W100%METHANOL <br /> ❑35. UNKNOWN <br /> W4. STEEL CLAD WIFlBERGLASS ❑ 9. FRP NON•CORROGBI°JAC:�ET ❑99. OTHER <br /> (Check ono.tem only) ❑ 2. STAINLESS STEEL �" <br /> REINFORCED PLASTIC;FRP) [i.0 COAT'_?ST=3 1 <br /> ❑ 5. CCNCRE=' <br /> GATE�NSTALLED <br /> TANK INTERIOR LINING ❑ t RUBBER UNEO ❑ 3. EPDXY UNING ❑ 5. GU55 LINING ❑95. UNKNOOTHER <br /> OR <br /> OR COATING I <br /> ❑ 2. AL:C/0 LINING ❑ 4. PHENOLIC LINING �. UNLINED ❑ O71•!ER (Forloca/w-on�y) <br /> (Check on-hent only) OATS INSTALLED <br /> OTHER CORROSIONa7a <br /> PROTECTION IF APPUG3t? ❑ I. MANUFACTURED CATHODIC y,�� FIBERGLASS REINFORCED PLASTIC 95. UNKNOWN <br /> PROTECTION ❑ a.-IMPRESSED CURRENT ❑99. OTHER <br /> (Far tool use ony) <br /> (Clock onedem orMy) ❑ 2. SACRIFICALANOOE <br /> SPILL ANO OVERFILL YEAR INSTALLED TYPE(For loory)l w0 orI OVERFILL pROTEC'TION EQUIPMENT:YEAR IN$TALLD 1 <br /> (Chest aI mat aapry) �1. SPILL CONTAINMENT &0e20 9 t.ALARM Z�•VJ �3• FILL Tu3E SHUT CFF VALVE OC'J <br /> Z. CROP TJBE <br /> rt ❑ 2. BALL FLOAT ❑ e. EXEYPT <br /> 11 <br /> 011. STRIKER PLATE <br /> fV.TANK LEAK DETECTION <br /> IF SINGLE WALL TANK(Check ad Nat aoaM: 'i IF DOUBLE WALL TANK OR TANK WITH SLACCER(Check one Mm aOM: <br /> I (EXPOSED PCR i1CN ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) ❑ t. VISUAL(SINGLE-WALL IN VAULT CNLY) <br /> ❑ 1. VISUAL SI <br /> ❑ Z CONTINUOUS INTERSTmAt MONRCAING <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ S. VAOOSE ZONE <br /> ❑ 3. CCNTINUOUSATG ❑ 7. GRCUNOWATER ❑ 3. MANUALMONITORING <br /> ❑ A. STATISTICAL INV ENTCRY RECONGL:ATICN(SIR)• ❑ d. TANK TESTING <br /> BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE i <br /> ESTIMA'D CATE c UST USED(YR;MO/CAY) <br /> EST:MAT_D CUANTf7Y OF SUBSTANCE REMAINING 4.75 TANK FILLEO'ITH INERT MA T-_RIAL7 <br /> gallons ❑Yes ❑No <br /> ForT:eny SV4RCB Fan 3 <br /> CUPAF0RP.1(4i99) <br />