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UND <br /> pRE�GRAM CONSOi�DATEDOR1VI <br /> UNDERGROUND'STORAGE TANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(one form Per UST) 430 <br /> TYPE OF ACTION (Check title item o*. For as UST pamRnent cWgm or rmoval,complete a*thin w onand Beeticas I,IL CHANG Og 1N lu,IV <br /> ® IOanaN mow) ` �I <br /> L� 1.NEW PERMI 3.RENEWAL PERMIT 8.UST REMOVAL q1 <br /> p 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CI 430a ON SITE <br /> DATE MIMING -DISCOVERED: <br /> DATE UST PERMANENTLY CLOSED: <br /> v. i <br /> FACII.TI'Y m#(Agency WeOW <br /> 3 <br /> BUSINE 3 NAME as tPAC N or DBA B <br /> t Iat <br /> � Los CITY <br /> 7BUSI�NEISS D <br /> CONM <br /> TONIC ID# 1 a3a TANK <br /> ANK MA}vUFACTURERas3 Q A STAND-ALONE TANKT <br /> ckox <br /> am a for 1 <br /> DATE US?SY5 T 135 TONIC CAP IId GALWN3 as439 <br /> fi NUMBiiit OF MPARTMEN IS IN THE UNIT <br /> C"Ol�i <br /> TANK USE MOTOR VEHICLE FUELING W )b.MARINA FUELING ❑ 5, AVIATION FUELING. <br /> 3.CFIEMICAL PRODUCT STORAGE C3iome 4.HAZARDOUS WASTE(bUsxd Oil) ❑ 5,EMERGE NCY GENERATOR PUffi.(1t6C l252a ts(e)] 43k <br /> [36.OTHER GENERATOR FUEL ❑ 95.(INIINOWN 99.OTHER_ ): <br /> CONTENTS PETROLEUM ❑ is REGULAR UNLEADED ❑ is MMMADE UNLEADED ❑ lb.PREMIUM UNLEADED <br /> W3.DOM ❑ S.JET FL19L ❑ 6.AVIATION GAS 4404 <br /> Q 8.PEMLEUM BLEND FUEL M 9.07HER PETROLlUMM:(3S - ): <br /> NON-PE ROLEU7.USED OIL U 10,ETHANOL 440, <br /> I1.OTf1mtNON-PSL'R0LEUf4 S ;:t• .;a•' <br /> .. ..;,. �* <br /> ". <br /> 7.7 <br /> TYPE OP 1.SINGLE WALL '.,Mll DOUBLE WALL 95.UNMOWN � <br /> PRIMARY CONT13 3.FIRMLASS U 6.WnMMAL BLADDER 444s <br /> ❑ 7.STEEL'S DnmtNAL LINING ❑ 95.UNKNOWN ❑ 99.OTl48R 3 eaiLv): <br /> SECONDARY CONTAINMENT 1.STEEL 3.FIBERGLASS [] 6 EXTBRIOR 13RANli I QdSR 7ACKF FED �1 � 44la <br /> 90.NONE 94.UNKNOWN' 1:199,OTHER(Succ . 4s2, <br /> OVBRFu.L PREVENTION AUDHILE&VISUAL ALARMS 2.BALL FLOAT u 3,FILL TUMFFVALVE <br /> ❑ 4.TANK MT T S FOR E(BbUPMN FROM OVERFILL ... .... <br /> Pwl,'wmN <br /> VERFILLpRBVENTION EOLJIPMBNT <br /> , <br /> PIPING CONSTRUCTION 1.SIIZGLI].wALLIM 2.DOUBL&WAILEDQ 99.OT'HER456 <br /> SY81 E!d TYPE PRHSSi7RE 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION 4.SAFE SIJ MN CO CCR 2636(°1(3)1 <br /> PRIMARY CONTAINMENT I.STEEL FIBERGLASS 8.FLBXI]3LE 10.RIGID PWSTIC _ <br /> ❑ 90.NO ❑ 95.UNKNOWN Cl 99,OTIER(Soni : 464b <br /> SECONDARY CONC MENT 0 1.STEEL. .TMERGFASS Ll 8.Fu1(ISLL ❑ 10.RIGID PLASTIC <br /> O 90.NONE 9s.UNKNOWN ❑ OTHER(Smft <br /> NONE <br /> Pa' CONTAD NT SUMP TYPE' <br /> 'A�� <br /> V R - <br /> •. 464. <br /> VENT PRtIvFAR CONT u 1.STEEL 4.F4BERGIA5$ U 10.RIGID PLASTIC 0 90.)ONE 099.OTIIEit(SP CAY <br /> SFiCOND Y CONTAII�IIVfENT 1.STFiB[ FIBFOtGLAS3 10.RIGID PLA C 90.NONE 99,OTHER S"Cw) 464t) <br /> VR pRIMARY C AINb1SNT 1.STEEL 4.MERGI 4SS ❑ Ill.RIG ft <br /> PLASTIC 90.NONE 9.OTHBR(Spuoi t <br /> VR SECONDARY CONTAINMENT 1.3TEEI, to.RIGID PTASTIC 90. ONE V9,OTHER(SPNitY) 4dal <br /> VENT PIPING TRAM ON SUMPTYPE 1.S WALL DO T.L WALL 90 NONE 4641 <br /> RESER PRIMARY AINMBN P 1.STEEL ERGLASS 10,RIGID PLASTIC 90.NONE 99,alum( ) l <br /> PIM SECONDARY CONTAINMENT l.ST13EI. <br /> FIBERGLASS 0-10-MIDPLASM U.90.NONE 099.OT1L8R(SPea$') 464k <br /> FILL COMPONENTS INSTALL F.D 1.5PIId.BUCKET 3.STAR PLATEMOTTTOM R Al2 TF SUMP <br /> .. ... ... ... 'r' _ <br /> 3 :.:. ..... a6e. <br /> CONSTRLIC ItON'TYPB ❑ 1.SIN4iIB WALL 1iVALL „❑ 3.NO DISPEN813i1S 90.NONE <br /> CONSTRUCTION MATERIAL <br /> 1 !�•,.•. <br /> .STEEL <br /> STEEL.COMPONENT PROTECTION Q 2.SACRIFXNAL ANODE(S) ❑ 4.IMPRESSED CURRENT E3 6.ISOLATION <br /> C)rRTIDICATI0IV:Z comfy that this is co a with the <br /> heaardous sobstanee stored ona thllt the Inrprtltlttlpn providtd herein is 9M%X"rs% <br /> and in full so <br /> APPLICA5NA <br /> TURE DATE /+ <br /> 47Z. <br /> rC 47t. APPLICANT i' �L� i9 ''✓ �� <br /> APPLICA ( <br /> =r�F <br /> Rev.(1=007) <br /> UPCF UST-B-IM <br /> U 'd E0:91 6002 L BnV O1 MV60Z:xe3 10d 30 NVA <br />