Laserfiche WebLink
w <br /> V <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS �I <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> IF (two pages�r tar.:; <br /> Page _ c. _ <br /> TYPE OF ACTION ❑i.NEW SITE PERMIT C14.AMENDED PERMIT cl9.5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE <br /> (Check one item only) ___ ��\ ❑ 7. PERMANENTLY CLOSED ON SITE <br /> ❑3.RENEWAL PERMIT (Spe&/reason-for local use only) (SPed/charge-f/ only) ❑ S. TANK REMOVED 430 <br /> FACILITY 10 e <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doug Businass As) <br /> LOCATI N Nd THIN SITE(OpBbra) 431 <br /> I.TANK DESCRIPTION <br /> FAo-5 <br /> K 10 e Z TANK MA ACTURER COMPAR7ME t?Aes%Complete one page fair each. <br /> TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> GATE INSTALLED(YEARMO) <br /> In <br /> A001TI0 AL DESCRIPTION(Faf/aaal use only) <br /> II.TANK CONTENTS <br /> r2. NON-FUEL <br /> NK USE 432 PETROLEUM TYPE <br /> T1 ❑ 2. LEADED ❑ 5. JET FUEL <br /> EHICLE FUEL TI-4a REGULAR UNLEAOED <br /> ete Petroleum Type) ❑ S. AVIATION FUEL <br /> PREMIUM UNLEADED I ©C- ❑ 3. DIESEL <br /> PETROLEUM ❑ 4 GASOHOL ❑99. OTHER <br /> Ic. MIDGRAD'c UNLEAD-EDL PRODUCT CAS 0(from Hazanicus Materials Inventory page) <br /> COMMON NAME(.from HasarJous Matenals lmfentory page) � <br /> ❑ 4. HAZARDOUS WASTE(Includes , <br /> Used Od) <br /> 95 titlKNOwn <br /> 111.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALLWITH ❑ S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> (Check one item only) `,�2. DOUBLE WAIL ❑ 4. SINGLE WALL IN A VAULT <br /> ❑99. OTHER <br /> TANK MATERIAL-DAmary lark ❑ 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC <br /> ❑ 5. CONCRETE ❑95. UNKNOWN <br /> (check one item only) C1 2 STAINLESS STEEL ❑ 4 STEEL CLAD W)FIBERGLASS ❑ 6 FRP COMPATIBLE WI100%METHANOL ❑99 OTHER <br /> REINFORCED PLASTIC(FRP) <br /> FTANKMATERIAL-secondary tarn ❑ 1 BARE STEEL ❑ 3 FIBERGLASS I PLASTIC ❑ 6 FRP COMPATIBLE W/100%METHANOL ❑95. UNKNO`PN <br /> one item only) ❑ 2. STAINLESS STEEL ❑ a STEEL CIAO WIFIBERGlA55 ❑ 9. FRP NON•CORROOIBLE JACKET ❑99. OTHERREINFORCED PLASTIC(FRP) ❑10 COATED STEEL❑ 5 CONCRETEDATEINSTALLEDINTERIOR LINING ❑ 1. RUBBER LINED ❑ 3 EPDXY LINING ❑ 5 GLASS LINING ❑95. UNKNOWN433 <br /> OR COATING ❑ 6. UNLINED ❑99. OTHER <br /> ❑ 2. ALKYD LINING ❑ a. PHENOLIC LINING (For local use cr;p <br /> (Check one item ant) DATE INSTALLED I <br /> OTHER CORROSION 434 <br /> PROTECTION IF APPLICABLE ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC 95. UNKNOWN <br /> PROTECTION ❑ 4. IMPRESSED CURRENT ❑99. OTHER (Forlocal use orty) <br /> (Check one item only) ❑ 2. SACRIFICIAL ANODE <br /> SPILL AND OVERFILL <br /> YEAR mSTALLEO TYPE(Forlocal use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Check all that apply) ❑ 1 SPILL CONTAINM=NT ❑ 1.ALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> DROP TUBE "b l ❑ 2. S ALL FLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> IV.TANK LEAK DETECTION <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER(CAeck one item only): <br /> IF SINGLE WALL TANK(Check all that appy)' <br /> ❑ 1. VISUAL(EXPOS-c0 PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WAIL IN VAULT ONLY) . <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ S. TANK TESTING <br /> BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> 435 TANK FILLED WITH INERT MATERIAL? <br /> ESTIMATED DATE LAST USED(YR(MOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING <br /> _ <br /> gallons - ❑Yes ❑No <br /> FDrmedy S`1,,RCB Form 8 <br /> nr-A C^DAA rA/001 <br />