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04/18/2013 11:48 2093344664 #5032 P.009 /020 PVI <br /> 1 T i i I <br /> UNEFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK tpj <br /> F� OPERATING PERMIT APPLICATION-TANK INFORMATION f..>.usi) ;\Rev <br /> TYPE OF ACTION (check wie Iturn only, FUST pft=mmt dosare or removal,cow-kft only this - -and SOWoSetonsI,ll,1%TV.WW LX below) 430 <br /> FU <br /> • <br /> 0 1.NEW PERMPERMIT- F-B'RENEWAL PERMIT 11�5CHANGE OF MORMATION <br /> El 6.MLPIRARY UST CLOSURE Q 7-LIST PURMAMDff CLOSURE,ON SITE [I S.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED; 4M DATE EMTING UST DISCOVEREDr 430 <br /> .................... <br /> ziammmM I,., <br /> FACILITY ID#(Agomy Use 0*) <br /> BUMM- SNAME( aFA(;ILrIYNAME orDSA- BUM=As EN"T <br /> BU ADD ,ns <br /> CITY104 <br /> ......... ......... <br /> TANK ID# 437 TANK MANUFACTURER 433 TAM TIM TANK W <br /> D 1,A STAND-ALIDNE TANK <br /> W.ONE IN A C"ArTMMq=UW. <br /> DATE LIST SYSTANTO <br /> Cm�*-wompWipr Bub commomm"w dwu2k <br /> _Tr <br /> 'oALW 435 TANKCASPA'I4m NUMBER WOMPARTMENTSYNniEUNIT- -11 <br /> _CI-17W GALLONS <br /> TANK USE 45;j&MOTOR VoiKLE FUFjjNG 11 IbMARINA FUELIM ❑ k AVIATION FLJPS LNG <br /> D&CHWICAL PRODUCT STORAGE 0 4.HAZARDOUS WASTE amdudumaoi) El 5-EMERGENCY GENERATOR FUEL[WW2gL5(0 <br /> Q 6 OTHIRGENERATOR FUEL 0 95,UNKNOWN 0 99.OTHER(spcdfy} 439a <br /> CONTENTS Pukouum; 0 1&REGULAR UNLEADED Cl lc.MIDQRADEUNLEADED S-lb-PREMIUM UWLEADIED 440 <br /> L3 3.DIESEL ci 5-mrFUEL [3 6.AV)AI1ONGA$ <br /> 13 &PETROLEUMBLEND FUEL 0 9 onmpmRoLeum (spotify), 44ft <br /> NON-PETROLEU)d:E37.USED OIL E3 lo:mmAmm <br /> *soft 44* <br /> RE, <br /> . <br /> -'•',«"•...... <br /> na <br /> TYPE OF TANK Q I.SMILE WALL <br /> -W2.DOUBLE WALL Ll 95.UNKNOWN 443 <br /> PRDAARV CONVIZOF-niWrii ymygra a 9.WYERNAL BLADDER- 4"7.STEEL, ri STM0,+INTERNAL LJNM -----P-".UNKNOWN 0 99.OTHEk <br /> 'ffiN-TADAMNT �k F, 44ft <br /> SECONDARY 0 1.STEEL - -FIBERGLASS -E36-EaWORMEMBRANE L-uex 07.jAcKrm - "5- <br /> 13 go.Now Ll 95.UNKNOWN o" (Suodfv): � 4452 <br /> OVERFILL U 1.AUDELE&VISUAL ALARMSEl 2.E=F-Or .FILL TUBE SHUT-OFF VALVE 4S7 <br /> ❑ 4.TANK MEETS REQUIREMUM FOR EXEMPTION FROM OVERRU FREVENTVN EQUIPMENT <br /> ------ El i.SWak-WALIM �.,"2,DOUBLE-WALLED g 99.OTHER 40 <br /> PM*CONSTPUCVON Ma�l� <br /> ol <br /> SYSTEM TYPE 4QJ�PRIMURE Ll 2.GRAV17Y 0 3,CONVENTIONAL SUCTION ❑t SAFE SUCTION zi CCRi2aft)(30 452 <br /> MJAFLY CONTAMMDU 'E3 i-srEEL FIBER &FL43UME ❑ 10.RJOID-P-LASM 464 <br /> LI 90.140M 0 99.OTHmspeafy), 464 <br /> SECONDARY MNTAjRN;hMJENT 0 I-STEEL, FTSERGL6-q$ U &FLEXIBLE ❑ 10.RIGID PLASTIC 4&6 <br /> Q 90.NONE 95.UNKNOWN El 99 oTtm(specify): 46ft <br /> PmcT?UpamC0NTAMffNTSUMP TYPE OWALL 0 2-DoMLE WALL 469 <br /> 90 NONE <br /> mi q0"WWRO *0909- 25 <br /> VENT FRVAARY CONTAMNENT • <br /> 4a,].STEEL U 4.FIBERGLASS 0 K RIGM PLASM LJ 90.NONE 0 99.ujmm(%mcw) 464s <br /> 46$el <br /> VENT SEMNDARY CONTAE44MM JFW-mtMM U t FWEwWS E3 lo-RIGID PLASTIC- argo--Rm-p--ff-99 OTHbM(SPwify) 464f <br /> VRFRA4ARYC0NTAnqMMff 4.FIBERGLASS 0 10.ffG-lD RASIX El go.NONE L3 99.o7m(sie�,fy} �% <br /> VRSECOND A-EY-CWTAINMENT 0 I-STEM 4.FIBERGLASS46V <br /> 0 I0,RIGID PLASTIC H(Wa NONE [3 99.oTm 464h <br /> VENT PIPING N SUMP TYPEJaI.SD40LFWALL n 2 Dousix wAff .NONE <br /> RISER PRDAARY CONTAINMIENT qk L STEM U 4 FIMGLASS 0 10.RIGID PLASM Ll 90.NONE 0 99.OTHER ftwtfy) 46q <br /> RIM ECONDAkY00NTATNmoENT-- 0 1.STEEL W4.FIBERGLASS El 10.RIGID PLASTIC 1-1-90.NOME Q 9-9. <br /> SPILL u 464kl <br /> _!�ILLODUPONENTSIMTALLED PLATEWWOM SLUP 4lwc <br /> 2.DOUBLE W <br /> 0 ALL <br /> 44% <br /> W. <br /> CERTMCAMON.-Icertify th tbbl*r iscompatible with the hBmxOm smbftjKe SWrcd and that am Lo formams prqvkm here m is <br /> tw <br /> and hwal rtaakvxmmft <br /> �APPLICANT SIGNATURE -FDAT E 7rl 40. <br /> APPLICANT NAME ofidjjs� 471. APPLICANT Tilu -7-An <br /> Upcv UST-B-m <br /> Rey,(UrAMM <br />