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<br /> UNIT'MD PROGRAM CONSOLIDATED FORM'
<br /> MIRGROU"STORAGE TANK
<br /> OPE+RAVING PERMIT APPLICATION.-TANK INFORMATION(one form per u5T) 430 L�
<br /> TV.old IX
<br /> TYPE OF ACTION (Cheek one item only. For�UST peratanam closure orremoval,complete only thi8 Q S.CHm andANG OeedomF(INFORMATION below) 'd
<br /> 3.RENEWAL PE AM
<br /> Q 1,NEW PERMFT S.UST REMOVALri 43�
<br /> 6,TEMPORARY UST CLOSURE � 7.UST PL'RMA1dENP CLOS RB ON SITE
<br /> DATE UST PERMANENTLY CLOSED: _
<br /> ATB
<br /> MEN ID#(Agemy Use OsaY)
<br /> BUSINESS E e as FACILITY NA]'1E DBA.Doing
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<br /> BUMS-St SrrE ADMSS
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<br /> :. .. .. .: ..'>.•. � -� l<IS 431
<br /> TANKMANUFVal' BR 433 TANK OONFIG[3RATtON:TiSSTAN
<br /> TANK ID ❑1.A STANTANK
<br /> ^� T^
<br /> [72.OM IN A COMPA
<br /> ,A COMPA3:tUDT8D UNIT
<br /> 6 NUMB11Ct OF COMPARTM$NTS 1N RHS tJNrr
<br /> DATE UST SYS �ISTALL3ID K _ ALLONS
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<br /> TAN �
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<br /> ME
<br /> 1. O to.AVIATION FIMLM 439
<br /> TANK USF �1 1a,MOYOR VBI4rCLB FUELING O 1b.MARIIiA F<7Bi�iG s.P ENCY GENEXATOR FtM(M i2MIA J1 439a
<br /> �] 3,CHP&CAL 4RODUCT STORAGE O 4•IIAZARDOUS WASTE Qat Uxd ID) ❑
<br /> Q 6,OI}1EkGEHPRAD Ji31. 0 9s.IDW40WN 0 99.OTIIFA 02!2!m:
<br /> CONTPETROLEUM: Ia.RsuuLAR UNLEADED 0 1C.Iv>IDc RADfitJ13LEADED O ib.PRENIIUbIUfTLBADEfl
<br /> MM
<br /> 5.JET FUEL. O A AVIATION GAS ,�
<br /> ML P OLEtJM aLEND FUST. LI o IUM is
<br /> NON-PETROLWK 7.USED OIL '
<br /> I1.OT11SRNON4STRO pj
<br /> ..s � ,. '. r ,.. .• 443.
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<br /> Ty-PI-OFTANK ].SINGLE WALL 2,DOUBU WALL U 95.UNDIOWN M/
<br /> PRIMARY CONTAIIOdBNT STEEL 0 3.FIBERGLASS Q 6.WrERNAL BLADDER 4441
<br /> O 7.STEEL+INTERNAL LINING 0 93,UNKwM 0 99.OTHER 7.JACt0;1 ED � �f' 445
<br /> 5ACONDARY AII�MEN7 STEEL 0 3•FIBERGLAS$ Q 6.1;7LTERIOR MEMBRANE LINER f^" 445a
<br /> 90.NOME 95.171VKNOM1VN ❑99r OTHER ifY): 4sz.
<br /> OVP.RFII.L FREVENTION 1.AUDIBLE 8G VISUAL ALARMS 2.BALL FLOAT 3.FILL TUBE SAUT OFF VALVE
<br /> 4.TANK MEETS
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<br /> CO `I'F
<br /> . •460
<br /> PIPING CONSTRUCTLON Ll1.SD1GL&WALLBD DOUBL&WALIBD ❑99.ORMON 456
<br /> SYSTEM TYPE PRESSURE 2.C:RAv11Y 3,CONVfits]lOAL SUCTION 4.SAFE SUCTION C23 OCR 6368 3 464
<br /> FIBERGLASS Q sr FLEamx 0 IO.RIGID PI ASTiC
<br /> PRIMARY CONTAINMENT S7E8I. "'
<br /> _0 90.NONE D 95.IBERO WN D L LLE =Z. 10,RIGID PLASTIC
<br /> 000-NAARY CONTADOdr- STEE1. F®BRGLASS 9 4me
<br /> u 90 NONE UNKNOW(( 099.OTI�R( 464d
<br /> NTADQ"'T SUMPTYPS i;' •'
<br /> P1P1NGrrI1R$II'Ifi CO .. . ... :.. ,.. ... ... �4.., .}.a;:,,,;, «},•;,
<br /> :•. G� (SpewfY) 464x.
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<br /> 1.STEEL FiBERG[ASS 10: PLASTIC 9&NOM U
<br /> VENT pRiMA31Y A1NMSN[' 99 OTFIBR t
<br /> -VWr1.STEEL FIS IHSS )0.RIGID PLASTI 90.N ONE 99.OTHER(Spec 41
<br /> SBCpr1DARY CONTAINMENT 4664P1
<br /> PRPdpRY CONTAINMENT 1.STfiEL F03ER0 5S 10.RIGID PLASTIC C1 90.NONE 0 99,OTHER(SPM* ) 464
<br /> h
<br /> VR SECONDARY CONTAINMENT ].STEfi WI ASS p I0.RIGm PLASTIC 90:NONE 99.OTHER(Specify) 464121
<br /> a.I>a WALL NONE 464
<br /> VENT P0?ii1VG ON SUMP'CYPfi i.SINGLE WALL I
<br /> RISER PRiN1AR CONTAII�Mt:NT i,STY36I. .FIBER LASS 10.RIGID PLASTIC 90.NONE 99,OTEZER(Spx� ) ,
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<br /> RRIER SECONDARY CONTAINMENT 1.STEEL FIBERGLASS L3 ]0.RIG»y PLASTIC eci
<br /> 90,NONE 99.OTB8R(Spfy) ,
<br /> M PROTECTOR CONTA;NMENT SUMP Iro
<br /> PILL COMPONENTS a3TALL - 1.SPILL BUCKETM 3
<br /> ;Pt .. 2,DOLMA WALL D 3.NO>M�ENSERS 90.NOM We
<br /> CONSTRUCTION TYPE ALL Jff S
<br /> CONSTRUCTIQN MATERL4L i' 1 _
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<br /> ��pppp�� lO.RIM PII+STIC
<br /> STEEL COMPONENT PROTECTION O 2,SACRIFICIAL ANODE(S) ❑ 4.IA1pRES5ED CURRENT 0 6.ISOLATI dI6
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<br /> CERTiFICATION:Y cer! em' e wlth the harrdoua sabstsace stored sad that the iaformstiva prol6ea dherda is erne,
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<br /> APPLICANT SIGNATURUZ ' , DATE 0 /
<br /> APPLICANT NAME 4 I' APPLICANT TfCLB
<br /> UPCF UST-B-1/2
<br /> 01 'd Z0:91 6002 L $nd 0L6L99b60Z:Xe3 10d 30 NVA
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