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UNIFIED PROGRAM CONSOLIDATEDQ*s <br /> UNDERGROUND STORAGE TANK <br /> OPERAM G PERMIT APPLICATION-TANK.INFORMAITON(one tam usn <br /> TYPE OF ACTION (Check one item only. FaUST permanent closure or mmovak comps ay Ibis ambon and Sem I,4 I.IV.and Dc below) moi► <br /> ❑ I.NEW PERwr 3.RENEWAL PERW113 ❑ 5.CHANGE OF IINFORMATION <br /> 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE 8.UST REMOVAL - <br /> DATE UST PERMANEN LY CLOSED: 43 DATE E7CISTINo UST DISCOVERED; <br /> :.L.FACTLXrY:n�fFO <br /> RMATION . <br /> FACILITY <br /> BUSIIVESS N (Same as NAME DBA- Buaimaa Aa) j <br /> G t had ` w <br /> BUSINESS Sjjgr% CIT, <br /> wn a( <br /> TANK.ID# 43Z TANKMANUFACIURER 433 rA CONFIGURATION TmSTANK IS <br /> 4341 <br /> C((�� <br /> j /� �A STAND-ALONE TANL <br /> -T44 Q 0d ei ses ❑Z.ONEINACOIIPARTmpMIDUMr. <br /> DATE UST SYSTEM IIIS'TALLED 433 TANK CAPACITY IN 436 GALLONS aneOF fa:a� t,dooet <br /> G p B NUMBER COMPARTMENTS IN THE UNDP 43740 <br /> - MT-NICtT.ST►=ANTI)CONT1�11PrS <br /> TANK USE �,'Ia MO?oR VE mCLE FUE UNCI 430 <br /> D 3.C1ffiMICAL PRODULT STORAGE ❑ Ih MARINA FUELING D Ia AVfA't10N FUBLQ�Ad <br /> Q 6.076. 3 CALFR DUCTSTOR O D 4.HAZARDOUSWASTE(tdidsLT iou) Q 3.8lIIIIR(ENCYGBNERAMRFUELIMCI=L$(o)) <br /> ❑ 93.UNKNOWN 13 99.OTHER mpecift, 4N& <br /> CONTENTS PETROLEUM: Q IL REGULAR UNLEADED 13 la MIDGRADE MEADED ❑ 1 h PREMIUM UNLEADED 448.DffSEL Q s.JET PUEL ❑6.AVIATION GAS <br /> ❑L PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM 410 <br /> NON4ETIROLEUI&E3 7.USlID OIL ❑ 10.ETHANOL <br /> 13 11.07MNDN4%ROLEUM S <br /> _ v..TArorscila�N - <br /> 6Mt. <br /> TYPE OF TANKQ 1.SINGIZ WALL WZ DOUBLE WALL 9s 11NKtNOvvAT <br /> PRIMARY CONfAEaIENI' I.STEEL COO.FIBERGLASS ❑6.LN-ORNAI,BLADDER 443 <br /> 443 <br /> D 7.STBII.+1ArTERNAL WING ❑9s.UNKNOwN ❑99.OTHER 4ft <br /> SECONDARY CONTAINMENT ❑ I. <br /> Cl ERGLASS ❑6 EXTERIOR MEMBRANE LINER 7.JACKETED <br /> 90.NONE 9s.UNKNOWN 99.OTHER 46 <br /> 149a <br /> OVBRFML PREVENTION El L AUDIBLE A VISUAL ALARMS 2.BALL PLOAT IKX FILL TUBE SHUT-OFF VALVE <br /> D 4.TANKMEBTS FOR EXEMPTION FROM OVERFILL PREVENTIONEQUTPNEa <br /> A&T$`PIPING<C'ONSTRUCITON <br /> PIPING CONSTRUCRON I.s1NGLF-wAI.I.ED DovBL6-w 9g.07TT <br /> SYSTEMTYPE 1.PRESSURE 2 GRAVITY 3. ar <br /> CONVENTIONAL SUCTION 4.SAFE SUCTION OAt 42 <br /> PRIMARY CONTAINMENT I.STEEL W4.FIBERGLASS Ll L mwum E 13 10.RIGID PLASTIC 464 <br /> ❑".NONE ❑ S.UNKNOWN ❑99.07NFR(SpccifI64a <br /> SECONDARY CONTAINMENT 13 1.STEEL. JiL4.FIBERGLASS Ll 8.FLEXIBLE 10.RIGID PLASTIC 466 <br /> ❑".NONE 1395.UNKNOWN ❑".OTHER,(Sway) <br /> PIPINGI TURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL 2.DOUBLE WALL 90.NONE 461d <br /> AFOR`RECO (VR)AND R SER>I IF.I�PIPL'PiPIl�TG`4b1113 'RiJC1T'of <br /> VENT PRIMARY COMAINMENT 1.STEEL .FBERGIASS 10.-PLASTIC E3 90.NONE 0 99 OTHER(Specify) <. 61e <br /> VENT SECONDARY CONTAINMENT E3 I.STEII, 4.FIBERGLASS10.RIGID PLASTIC .NONE u 99.omm(Specify) 4W <br /> VR PRIMARY CONTAINMENT I.STEEL 4.FIBERGLASS E3 !0.RIGID PLASTIC ".NONE E3 99-OTHER(Speeity) 461a <br /> VR SECONDARY CONTABO&EN 1.STEEL E3 4.FIBERGLASS U 10.RIGIDPLASTIC RW NONE E 3 99 onm(Sp..*) <br /> 464h <br /> VENT PIPING TRANSITION SUMP TYPE M I.SINGLE WALL 2.DOUBLE WALL St NONE 4"1 <br /> RISER PRIMARY coNTAINMFNT 1.STEEL 4.FIBERGLASS U 10.RIGIDPLASTIC 9%NONE E399 OTHER(Specify) 64L <br /> RISER SECONDARY CONTALIGOW S TEII. 4.FIBERGLASS 10.RIGID PLASTIC NONE 99 OTHER(Spedfy) 461t <br /> FILL COMPONENTS INSTALLED .SPILL BUCKET S7RIICIIt PLA 4641 <br /> TIJBOTTOMPROTECTOR 4 CONTAI�IM@R SUMP 4fles <br /> VZL UNDER'DISPENSER C0111TAIIvlV1C111T;(UDGj <br /> CONSTRUCTION TYPE156 1.SINGLE WALL E3 2 DOUBLE WALL ❑3.NO DISPENSERS p gp rpNgy <br /> CONSTRUCTION MATERIAL. 1.STEEL. FIBERGLASS 10.RIGID PLASTIC 99.OTIISR 4Mtbs <br /> CORROSION,PROTECTION. <br /> ' <br /> STEEL COMPONENT PROTECTION Q 2.SACRIFICIAL ANODES) Q 4.IMPRESSED CURRENT Q 6.13OLATION <br /> Dom.APPLICANT"SI( TATORE:. <br /> CERTIFICJ►71Om I aMtlyr riot thk UST ayatea b rrifY tr�mrdov a416aaaiee otofted aad float ria pmy� <br /> anal L fill wkr <br /> APPLICANT SIRNAIM - TE 2 , <br /> J �f <br /> APPLICANT NAME(print) 4171.1PLICANT <br /> TITEE <br /> f 0 ce <br /> UPCF UST-B-I!1 <br />