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Jan 10 03 04: 45p C ie Brown (2 461 -634 p. 1 <br /> - � � <br /> UNIFIED PROGRAM CONSOLIDATED FORM B <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> (Two Pages Per lade) <br /> Page I of_�& <br /> TYPE OF ACTION ❑ 1.NEW Pi-IMT ❑ 4-AMENDED PEIIMTT ❑S.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE +30. <br /> 3.RENEWAL PERMIT [3 7.PERMANENTLY CLOSED ON SITE <br /> (Chat one iwm only) (3 - - <br /> (Spmfy tea) (Spmify rc4xoa) ❑8-TANK REMOVED <br /> 1. <br /> BUSSESS NAME(Same asFAca.ITY NAME or DBA-Docig lu'$"sz As) �• FACILITY ID: <br /> W C) G 431. <br /> LOCATION WITHIN SITE(Opriooat) <br /> L TANK DESCRIPTION <br /> (A scaled plot plan with the Iocatioo of the UST system including buildings and Landmarks shall be atbndlIcd to the local agencYJ <br /> La353 432. TANK MANUFACTURER 433• COMPARTMENTALIZED TANK ❑Yes ® No 434, <br /> TANK In N 7 03 <br /> 3 U N i% N 6, W M r, d e v- )J , e I �� ( NJ 7 u-Yes•"�P-e o","for''p"'.DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437• <br /> (YE.ARJMO) <br /> 1 <br /> UN le, N 11 W 439. <br /> ADDITIONAL DESCRIPTION(For loaf ux only) <br /> IL TANK CONTENTS <br /> 440. <br /> TANK USE 439 PEI ROLEUM TYPE <br /> Ig 1.MOTOR VEHICLE FUEL ❑lb RE-oULAR UNLEADED ❑2.LEADED ❑5-JET FUEL <br /> (lfchecked.complc%e Pctmkum Typo) ❑Ib. PREMIUM UNLEADED 13.DIESEL ❑6. AVIATION GAS <br /> ❑ 2. NON-FUEL PETROLEUM ❑Lc.MIDMADE•UNLEADED (:14- GASOHOL ❑99.OTHER: 447- <br /> ❑ 3. CHEWCAL PRODUCT COMMON NAME(from IL-dws M-te`61s L--y Page) 441. CASA(from[U-doos Mat-ok h--w[y P-M) <br /> ❑ 4. HAZARDOUS WASTE <br /> (LxWo Used Oil) <br /> ❑ 95.UNKNOWN �Y I <br /> ILL TANK CONSTRUCTION <br /> TYPE OF TANK ❑1.SINGLE WALL ❑3.SINGLE•WALL WIITLEXTERIOR ❑5. SINGLE WALL WITH IN773LNAL BLADDER SYSTEM 443• <br /> (Chet one rtem only) MEMBRANE 11NER ❑95. UNT34OWN <br /> 6 2-DOUBLE WALL_ ❑4. SINGLE WALLIN A VAULT ❑99. OTJER 444 <br /> TANK MATERIAL-pimsyteak u 1- ARE STEEL 113.FIBERGLASS I PLASTIC 5. CONCRETE 95.UNKNOWN <br /> (Chafe nae imm only) ❑2. STAINLESS STEEL 0 4. STEEL CLAD WIMERGLASS ❑S.FRP COMPATIBLE ❑99.OTIMEt_ <br /> REINFORCED PLASTLC 7tP Wl100%METHANOL <br /> TANK MATERIAL-secondary tmk I.BARE STEEL ©3.FIBERGLASS!PLASTIC ❑8.FRP COMPTMLE W1100%METILANOL ❑95.UNKNOWN 445. <br /> (Cbcek one item only) ❑2 STAINLESS SIi-EL,■4.STEEL LAD PL.AE (FRP) [3 10. COALED STEEL <br /> GLASS 0 9.FRP ABLE JACKET ❑99.OTHER <br /> ❑5. CONCRETE <br /> TANK INTERIOR L4I1NG 1.RUBBER LINED ❑3,EPDXY LINING ❑5.GLASS LDRNG 95.UNI.NOWN 446. DATE INSTALL L•D 441. <br /> OR COATING ❑2.ALKYD LINING ❑4.PIMNOLIC LINING ❑6.UNLINED ❑99.OTHER <br /> Che&-one item only449. DATE INSTALLED 449. <br /> 0713ER CORROSION ❑1.MANUFACTURE CATHODIC ❑3.FIBERGLASS RF3NFORCFIJ PLASTLC E395-UNKNOWN- <br /> PROTECTION PROTECTION ❑4.III'RESSEDCURREN'I ❑99.OTHER <br /> A Ii:;"C ❑2.SACRIFICIAL ANODE <br /> SPII L AND OVERFILL YEAR INSTALLED 450. TYLE 451- OVERFILLPROTECTION EQUIPMENT: YEAR I OFF V ED 452 <br /> (Check all that apply) e 1-SPILL CONTAINMENT LLL( �I-c-- 0 P"U ❑1.ALARM E 3.FILL TUBE SHUT OFF VALVE 3 <br /> 2.DROP TUBE O i -O`I -C 3 D-� CI 2.BALL FLOAT,❑4.EXEMPT <br /> (�3.STRIKER PLATE!/�✓ Nl r, r 7 P_ <br /> IV.TANK LEAK DETECTION <br /> (A descri on ofthe monitoring program shall.be submitted to the local agency.) <br /> a5I3. IFDOBLZ'WALL.TANKORTANK WITH BLADDER 454• <br /> IF SINGLE WALL TANK (Cbeck nuc item 00131) <br /> (Che&an that apply) <br /> E]1.VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2.AUTOMATIC TANK GAUGING(ATG) C16.VADOSE ZONE ■2.CONTINUOUS INTERSTITIAL-MONITORING <br /> ❑3.CONTINUOUS ATG [17.GROUNDV4 ATER ❑3.MANUAL MONITORING <br /> 04.STATISTICALWVENTORYRECONQI•LATION 08.TANKTESTING <br /> (SIR)rt B.Mt MAT,TANK TESTING ❑99• crrHER <br /> V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE <br /> 457. <br /> ESIIMATF.D DATE LAST USED(YMFO/DAY) ass. HS rDAATED QUANTITY OF SUBSTANCE REMAINING 456- TANK FIId ED E2Y[INERT No 1,1AT� 7 <br /> gallons <br />