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0711012009 10:34 2098585066TWO GUYS FOOD PAGE 06108 a 0 y� UNIFIED PROGRAM[CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERA'ITING PERMIT AMICATION-TANK INFORMATION (One form per UsT) TYPE OF ACTION (Check one item wily ror a USI~dosum or remmm(--rietr,only this section and See hms L 1(.111.1(?and IX fielow) 430• [03 1.NEW PERMIT ❑ 3.RENEWAL PERMIT 10.5,CHANGE OP INFORMATION b,TEMPORARY UST CLOSURE _ 7.UST PERMANENT CLOSURE ON SITE ❑ S.UST RFXOVAL DATE UST PERMANENTLY CLOSED: 430s DATF.EXISTING UST DISCpVERED 430b. L. IeACI-M UWORMATION FACTLfTY ID#(Agency use only) - �- BUSTNESS NAME(Same am Facility Now or DBA-Doing 8usi"mv As) }• WO &UYS f lO0 D F O l- RUSTNF.SS SITE ADDRESS f03. CITY 1�- �, 0 t-n ® P H. TANK DESCRIPTION. T.AyNNK�ID# 4P'- TANK MANUFACTURER 433. TANK CONFIGURATION;THIS TANK IS 434. 1 r7 Q Q pwffflews m� IG+N W I- A� ❑ 2,ONF IN A COMPARTMENTED UNIT �1 n rhe uaiL DATE UST SYSTEM INUALLED 435• TANK CAPACITY IN GALLONS 4315 NUMBER OF COMPARTMENTS IN THE UNIT 437, RI:, A;NI USE AND:CONTENTS. TANK USE In,MOTOR VRIOCLE FUELING ❑ 1h.MARINA FUELING ❑ I..AVIATION FUELING 439- 3.CHEMICAL PRODUCT STORAGE 0 0 [34.HAZARDOUS WASTE ond.ea una aS.EMERNC OEY GENWRATOR rUEL plsC 1252s1.5(C)I ❑ 6.oTitER GENERATOR FUnt. ❑95-UNKNOWN _ [3 99 omm(srmifyk 439m CONTENTS PETROLEUM; 5j Im REGULAR UNLEADED �❑ I..MIDGRADE UNI,FADP,D ❑ I b.PPEMIUM ummor-D 440, ❑ 3.DIESEL ❑ S.JET FUEL ❑ ft.AVIATION GAS © S.PETROLEUM BLEND FUEL ❑9.OTHER PETROLEUM JSP_ fy)�„ 440■- NON-PETROCEUM: 7.USED OIL ❑ 10,17MANOr. � ❑ I(.OTHER NON-PETROLEUM{ 44W IV. TANK CONSTRUCTION _ O_F TANK.. ❑ 1.SINGLE WALL ]� 7.DOUBLE WALL •(•YlsE' 95,UNKNOWN � aaa. PRIMARY CONTAINMENT _ © 1.STEM., n� IR 3.FIBERGLASS Q 6.INTERNAL BLADDER 444. _ __ ❑ �.STEEL+INTERNAL LINING _ ❑ 95.UNKNOWN 13 99.OTHER 444h.- SECONDARY CONTAINMENT�❑ I.STEM J43.FTBF.RGLASS - O 6,EXTERIOR MEMBRANE LINER E37,JACKETED 145• ❑ 90,{NONE ❑ 95.UNKNOWN ❑99.OTHER 5-r.�; 145a OYERFTLL PREVENTION ❑ 1,AUDIBLE&VISUAL ALARMS p 2.BALL FLOAT 3.TILL TUBE SHUT-01712 VALVE ❑4.TANK MEETS RE IREMT NTS FOR>`SMPTION FROM OVERFILL PREVENTION EQUIPMENT V:: RODUCT/WASTE PIPING,.CONSTRUCTI1bX _PIPING CONS7MUCTION L SINGLE WALL z.DOUBLE WALL 0 99.OTrilER _ _ _ 4M, SYSTEM TYPE 1.PRESSURE 2 GRAVITY .. 3_CON�!£NTIONAL SUCTION J2 (..SAFE SUC ION 1=3 CCR�2G36(ell�j_4�• PRIMARY CONTAINMENT 1.STEEL m 1 M1 m 4 F.FIBERGLASS m." ❑ s.FLEXIBLE ❑ Io.R1Gm PLAsTir 464. ❑ 90.NONE ❑ 9S-UNKNOWN TO 99_ATHER(SpccTFy�'�----- 4FP4'_.._ SFCONDJARY CONTAINMENT ❑ 1,STEEL ,(,8 4.FIBERGLASS - I] S.FLEXIBLE ❑ IO.RIOIb IR.ASTIC ❑ 90.NONE—— 95.UNKNOWN ❑ 99,OTHER(Sveci ): 4674 PIPINOITURBINE CONTAINMENT SUMP TYPE I.SINGLE WALL 612.DOUBLE WALL ❑ 90,NONE 4644, VL.VENT,VAFOR.RECOVEItX:: VR)SND:ItYSER/FII VP"� PU'ING:CONST�RUCTTON VENT PRIMARY CONTAINMENT 1.STEEL El 4.FIBERGLASS [3 (0.RIGID PLASTIC [390.NONE [3 99.OTHER(S(xdry)= 467ct .- - - VENT SECONDARY CONTAINMENT_ 1,REEL [34_FIBERGLASS ❑ 10.RIGID PLASTIC [390.NONE E3 99.OTHER(Specify)- 464f1_ VR PRIMARY CONTAINMENT I.sTEEL ©4.FIBERGLASS ❑ (0.RIGID PLASTIC Li'90.NONE ❑99.0THER(Specify): a�lgb VR SECONDARY CONTATNMENT _ i.STEEL ❑4.FIBERGLASS Q 10.RIGID PLASTIC Q 90,NONE❑ 99.OTHER(Spwiry): 464h1. MA_ - VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ®z DOUBLE WALL [390,NONE '' M 'RISER MIMARY CONTAINMENT PL I.STEEL ❑4.FIBERGLASS © 10.RIGID PLASTIC ❑ ".NONE ❑ 99.amm(Specify). 4•' RISER SECONDARY CONTAINMENT []STEEL ❑4,FTRRRGI.A,SS ❑ 10.RIOID PLASTICE L]Q 90,NON ?9.OTHER(Spcdly): kl 4513�- FILL COMPONENTS INSTALLED 1.SPILL BUCKET ❑ 3.STRIKER PI-ATP?AWfrIOM PROTECTOR ❑ 4.CONTAINMENT SUMP VH.::IIN�JDISPENSVR CON'I'i N IT>(I3DC) CONSTRUCTION TYPE. Q.1_SIMGLr WALT, Q 2 DOUBLE WALL ❑ 3.NO DISPENSERS ❑ ".NONE whew CONSTRUCT ION MATERIAL © 1.STEEL ❑4.FTBP.RGLMS 10.RIGID PLASTIC ❑ 99,OTH£R(Specify) 4694 VM.: .CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑2.SACRIFICIAI,ANOD 5 ❑ 4.IMPTtWrO CURRENT ❑6.ISOLATION 44$. ...?PLICAM SIGNATURE ' .. .. C1E11:'1`IFICA -.-1 eerttfy that this UST 0ystem Is conWadble whb the hazxWoas substance snored and that the informanat+ P Ix tFW, mearste,mid In cxira with kiwi reoubtnWAD. alp, APPLICANT SIGNATURE Dl►TE -`� s - APPLICANT NAME(print) T uIL, �`� 4� APPLICANT TITLE Uj V f d7z. f J IT UPCF UST-13 Rov.(IVM7)-I/Z ww►Y.tmidoes,orR � 4