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i <br /> UNHUD PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICA'nON-TANK MORMATION (one foams per UST) <br /> TYPE OF AC'T'ION (Check one item only. For a UST closure or remoM4 complete only this s+ecdon and Sections I.9 III,IK and D'below) 430. <br /> ❑ i_NEW PERMIT 0 3.RENEWAL PERMIT ❑ 5.CHANGE OF I1V'Y:ORMATTON <br /> ❑ 6-TEMPORARY UST CLOSURE 0 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 430a DATE E'STIlVG UST DTSCOVERSI): 430b. <br /> L .FACILITY. 'ORMATYON <br /> FACILITY ID#(slgency Use Only) I <br /> BUSINESS N.A119(Sams asFacllrtyName or DSA-,Doing Business As) <br /> BONFARE MARKET#35 <br /> BUSINESS 81TE ADDREss 103. csrX iO4 <br /> 15 E. ORANTLINE RD. YRACY <br /> RR. TANK DESCRIPTION <br /> TANK TD Il <br /> TANK MANUFACRM PR 4m• TAA*K CONPIGCJRATTON:TFRS TANK IS 434. <br /> TA 01400404 MODERN WELDING © i.ASTAND-ALoxr-rANK C*ggere omp�p fx eh <br /> 0 2-OM INA ComPARm xN=UNIT o=qK l=it&t l.& <br /> DATE UST SYSTEM INSTALLED 435• TANK CAPACITY IN GALLONS 416- NUMBER Off'COMPARTMEN'T'S IN THE UNIT 437. <br /> 3-1-1988 12,000 <br /> ]JI. TANK UWAND CONTENTS <br /> TANK USE ® la iAoTOR VEHICLE Az wG ❑ lb.MARINAFUFLING ❑ lc.AVIAT101\FUELING 499. <br /> ❑ 3.CRE=AL PRODUCT STORAGE ❑4 Pl'A DOUS WASTE(t4h144s Uecd O,7) 15.EMBRGENCY GENERATOR FUEL Nsc§252m.5(c)1 <br /> ❑ 6.OTIMR 67DOM4TOR FUEL. 0 95.LWKYOWN Q 99.OTHER(Specify): 439& <br /> CONTENT_8 PETROLt LW; 0 la 12EGTj1 AR UNLEADED 0 Ia MIDLIAAlM UNLEADED ❑ Ib.PPM d21L lUNLEADED 440. <br /> 0 3.DIMFRL 0 5.IETFUEL ❑ a AVIATTCW GAS <br /> ❑ 8.PETROLEUM ALE_ND FUEL ❑ 9.onM P'ETROLsum(specify). 440& <br /> NON PETROLEOM: 7,USED OIL 13 10-ETHANOL <br /> Q 11.OTHFZt NON-PETROLEUM 440b. <br /> TV. TAWC' 'ONSTRUCTION <br /> TYPE OF TANK ❑'1.SINGLE WALT. 0 2 DOUBLE.WALI. ❑ 95_UXrWOWN 443, <br /> PRIMARY CONTALNMENT ®'1.STEEL C] 3.FIBER61ASS C] 6.INTRIAL BLADDER � 444, <br /> ❑ 7 STEEL+IN IFI2NAL LINING 0 95.UNXNOwN ❑ 99 OTHER Specify): 444& <br /> SECONDARY CONTAINMENT 0 1.sTga 0 3.PDMRGLASS ❑ 6.BXTERIOR ME1vIDRANE LINER ❑ 7.JACKETfiT7 445. <br /> ❑ 90.NONE Ll 95_tDW.NOWN ❑99.OTHER(Spccify): 445& <br /> OYET ILL PREVBNIYON ® 1.AUDI6L.E&VIStTAL ALARMS 0 Z.BALL FLOAT []3.FILL TUBE SHUT-OFF VALVE 437, <br /> ❑ 4 TANKNffiETS MRMZMENTS FCR EXWP ION FROM OVF.RFMLPRPVEsmoNEQ mai-r <br /> 'V. Y'ROIJ�UC 'f WAS. PYPING CONSTRUCTION <br /> PUI NO CONSTRUCTION E3 i.swGu wAI.L 0 2,DOLMLE WALL ❑ 99.OTMER 460. <br /> SYSTEM TYPE ® 1.PRESSM ❑2.GRAVITRY 0 3.CONVEXTioNAL SUCTIOX ❑ 4.SAFE WCUONt23 CCR§26360(j) 4 <br /> GARY CONTAWMENT ❑ T$ ti 4,FTBER6LAss 1;3 8,FI'•I=LE ❑ 10.RI0Ib PLASTIC 464. <br /> 0 90.NCM 0 95.UmXNOWN ❑ 99.OTHER(Specify): 464a <br /> -SECONDARY CONTAINMENT ❑ 1.3TEaL 4.FJBERGLASS Q 8.FLEXIBLE - ❑ 10.RIGID PLASTic <br /> ❑ 90.NONE ❑ 95.UNIT ow ❑ 99,OTHER(Spstify): 464. <br /> PTPTTVO/TURB CONTAD MENT SUMP TYPE ❑ 1.SINGLrs WALL ® 2 DOUBLE WAIL ❑90.NONE 4544 <br /> VL 'SENT,VAPOR.RECOVERY")AND, ER/FILL PTFE PITING CONSTRUCTION <br /> VENT'PRIMARY CONTAINMENT M I.STEEL ®4,FIBERGLASS C3 10.RIOM PLASTIC C] 90.NONE Q 09.OTHER(Speeif,): 4"& <br /> 4 <br /> VENT SECONDARY CONTAINMENT ❑ 1.STEEL 0 A FMERGLASS ❑ 10.RIGID PLASTIC ❑ 9G.NIONE ❑ 99.OTHER(Specify): 464644 <br /> 444 <br /> VR PRIMARY"CONTAINMENT 0 I.STEEL 0'4.F] rT*LASS ❑ 10.RIGID PLASTIC ❑ 90.N01M © 99.OTHER(Specify)' <br /> VR SECONX)AFY CONTAINMENT ❑ 1.STEEL 0 4,FIEEROLASS Cl 10.RIGM PLASTIC 1] 90.NONE ❑ 99.OTHER(Specify,: 44.41. <br /> VENT PIPING TRANSITION SUMP TYPE 0 1.STNGLF WALL ❑ z DCUBLE WALL ❑ 90.NONt <br /> RISER PRIMAKY CONTAINMENT 0 1,STEEL LI 4.FIBERGLASS ❑ 10.MOM PLASTIC 0 90.NONE ❑ 99.OTHER(Specify): 4". <br /> RISER SECONDARY CONTAINMENT C3 1.STBE, Cl 4.FM=GLARSS © 10.RIGID PLASTIC ❑ 90.NOM ❑ 99.OTLIFR(SpecjW;: !{/A 464&1. <br /> PIIZ COMPONENTS INSTALLED ® 1.SPILLBUC T ® 3.sTa RPLATsoTrOMPROTECTOR <br /> iB trASUMP <br /> VM, UNDER DISPENSER.CONTAINiYLENT(UDC) <br /> CONSTRUCTION TTPE 0 1.SINGJM WAl L ❑ 2.DOUBLE WALL ❑ 3.NO DISMNSERN ❑ so.NONE 469& <br /> CONSTRUCTION MATERIAL Q ',STEEL ® 4 FIBERGLASS © 10.PIGID PLASTIC C3 99.OTHPR(Specify) <br /> VM STEEL, <br /> COMPO NEN T PROTECTION [] 2.SA CLACL CORROSION <br /> PROTECTION <br /> 4. SED CLII E T ❑ b.FSOLArI t 448. <br /> IX. APP1ACAN T SIGNATURE <br /> CERTIFICATION: I-UW that this UST sysMb is compatlbie with the Itilaw doM 809ance stared and that the bfo ;provide d helrpl>t£s true, <br /> accurate,and In faX oom yr th I mArements. <br /> APPLICANTSIQNATURE `T DAxe 12/1/2011 470. <br /> j APPLICANT NAME(print) AUSS MCLEOD APPLICANT TrME ;A1�.�?A D CTOR 4�2. <br /> TSG-3 Z10/800d 8£L-1. 8L95-8ZT-80tl S@ST.zd.zalud loodleN-WOHR 5Z:9T TT,-50-ZT <br />