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1k/22/2002 TUE 14:08 FAX 20" ' 3098 Equip Maint/Motor Pool 2002/003 <br />3 O\ <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND STORAGE TANKS -TANK PAGE 1 . <br />iM'7 Aaga7 per reni) <br />Page - el <br />TYPEOPACnON [] I. NEW SITE PERMIT ❑ 4. AMENOEDPERMIT U 5. CHANGEOOMFORMATION) ❑ e, TEMPORARYSITECLOSURE <br />(Ct+beltaneitem wey) ❑ 7. PEAMAN$NTLYCLOSWONSITE <br />Lb 3. RENEWAL PERMIT (5Pdcw -.4-Iwtoor ua40.*) (30#cei Chang@.)buccal wo a w ❑ E. YANK REMOVED 430 <br />CU5114E55 NAME 13a a as FAQUITY NAME Or OEA • Doing 9 W me sa As) <br />FACIUTY ID s <br />-'} <br />-- <br />,5AJf urr✓ a�,N <br />�Rooll�ISy <br />,s <br />k <br />LOCATION w"I" SITE (Op600ap {31 <br />/ / .$ r urn% -6 S <br />L TANK DESCRIPTION <br />TANK 10 p TANK MANUFACTUR/E�R <br />�7' <br />COMPARTMENTALIZED TANK Q Ysi NO <br />/r_ <br />OP X ex Ef <br />✓ <br />rt •Yes•. ea"IVIN ons papa t0r lace camps .went <br />DATE INSTALLED (YEA RrMO) TANK CMA TY IN rAA"QN$ <br />NUMB OMPARTMENT <br />ADDInONAL 0@SCRIPTIDN (FwWy vis en)IQ <br />IL TANK CONTENTS <br />TANK USE 432 <br />PETROLEUM TYPE <br />MOTOR VEMCU FUEL t• .41. <br />,,.,,� <br />L`2 to REGu1AR UNLEADED <br />C7 7. LEADED <br />❑ S. JET FUEL <br />(lrmirkad, compMre Piuohlim Type) <br />❑ Z. NON.FUELPETRGLEUM <br />❑ Sb. PREMIUM UNLEADED <br />Q 3. DIESEL <br />❑ 8. AVIATION FUEL <br />❑ 3. CHSMICALPRODUCT <br />❑ 1e. MIOGRAOEUNLEADEO <br />❑ 4. GASOHOL <br />❑ 99. OTHER <br />COMMON NAME (hom Hara/COas Mat44are r^" e,ftgj; Ys) <br />CAS • (homNa=alyovs45 M4hviatrmwMs'jPasrel <br />❑ 4. HAWDOUS WAST'_ flad CeJ <br />Used Olp <br />!I <br />I <br />III, TANK CONSTRUCTION <br />TYPE OF TANK SINGLE WALL ❑ 3.. SINGLE WALL WITH <br />❑ S. SINGLE WALL WITH INTERNAL BLAOOER SYSTEM <br />(Ch+Ck 000 4un(y) 2. OOUHLE WALL S EXTERIOR MEMBRANE LINER <br />❑ M. UNKNOWN ' <br />❑ 4. SINGLE WALL IN A VAULT <br />❑ yy OTHER <br />TANK MATERIAL •pdm.%'f Wk ❑1. BARESTEEL 3 FIBERGLASSIPLAST1C <br />❑ 5. CONCRETE 095. UNKNOWN <br />(Check am e+m only) 2. STAINLfO STEEL 114. STEEL CLAO WKIBERGLASS <br />❑ e. FRP COMPATIBLE W(16015 METHANOL ❑ 99. OTHER <br />REINFORCED PIA9T14 (FRPI <br />TANK MATEMAL- secondary Lank <br />CI 1. BARE STEEL ISYa F19ERGLASS! FUSTIC <br />❑ e. FRP COMPATIBLE w(rea)k METHANOL ❑ 93. UNKNOWN <br />(Check one ihm G*) ❑ Z. $TAINLEM STEEL d 4. STEEL CLAO WIFIaFROLA55 <br />d 9. FRP NONZORROOIBLE JACKET ❑ 99. OTHER <br />RaMPORCE0 PLASTIC (FRP) <br />1110. COATED STEEL <br />Ll 5. CONCRETE <br />TANKATING LINING 13 1. RUBBER LINED 11 3. voxY UNIN6 <br />ORCOCOATING <br />i. GLASS LINING ❑ 01. UNKNOM4# DATE IN5rAl.LEO <br />11Z ALKYD LINING E)4. PHENOLIC LINING <br />d B. UNLMfO C399, OTHER <br />onr Nem 0 <br />(forkcarme cAf7 <br />OTHER CORROSION <br />PROTECTION IF APPUCAE <br />❑ 1. MANUFACTUREO CATHODIC <br />❑ 3. FIBERGLASS AETNFORCED PIASnC 95. UNKNOWN 434 <br />GATE INSTALLLe-D <br />' <br />PROTECTION <br />❑ 4• µ1PRE55E0 CURRENT <br />❑ 99. OTHER <br />(Check a" rranr Ono <br />❑ 2 SACRIFICIALANODH <br />(FONoa✓ws On+y) - <br />SPILL AND OVERFILL. <br />YEAR INSTALLED <br />TYPE (Forlocal us* now <br />OVERALL PROTECTION EQUIPMENT. YEAR INSTALLED <br />(Check an mar appy) <br />1. SPILLCONTA)NMENT <br />�1. A= ❑ 3. FILL TWK 5HUTOFF VALVE <br />' <br />❑ Z. DROP TUBE _ _ <br />❑ 2. GALL FLOAT ❑ L EXEMYPT <br />' <br />03. STAIKER PLATE <br />- IV. 'iANKLEAKDETECTION ••`? :; <br />IF SINGLA WALL TANK ICbeck i9mara <br />If DOUBLE WALL TANK OR TANK WITH GLADOER &heckons3em ): <br />0 1, VISUAL (E)IPOSED PORTION ONLY) <br />0 S. MA.VUALTANK GAUGING (WrG) <br />VISUAL (GINGLE WALL IN VAULT ONLY) <br />Q Z AUTOMATIC TANK GAUGING IATG) <br />11 IL VADQSE ZONE <br />r©,r/1. <br />Cf Z CONTINUOUS INTMVIAL MONITORO+Q <br />❑ 3. CONTINUOUS ATC <br />❑ 7. *GROUNDWATER <br />❑ 3. MANUALMONTTORING <br />13 4. STATISTICAL INV:NTORYRMONCLLIATION(SIR)+ <br />04, TANK TESTM <br />' <br />BIENNIAL TANK TESTING <br />' <br />❑ 99. QTNe� .: <br />. <br />- V. TANK CLOSURE INFORMATION ) PERMANENT CLOSURE IN PLACE <br />ESTIMATED DATE LAST U58 MVMDCAY) <br />ESTIMATED OUANnTY OF S BSTANCE REMAINING <br />435 <br />TANK FILLED WITH McRTMATERIM7 <br />N <br />I <br />4w* <br />Ely. E] No <br />CUPAFORM (4199) FaMiON SWROS Form 8 <br />