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UNMED PROGRAM CONSOLEDATED FORM <br /> UNDERGROUNDSTORAGETANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION <br /> (one form per UST) <br /> Com W.1mb 0 m i 101 C a MWALININUgM, LYN I <br /> DATE UST PERMANENTLY CLOSED: 430,. DATE EXISTING UST DISCOVERED: <br /> 430b. <br /> wnRuin v=Iwo's I 1! 010 <br /> FACILITY ID#(Agency Use Only) <br /> -Wak"Wallmil <br /> BUSINESS SITE ADDRESS 103. <br /> 1501 NORTH JACK TONE ROAD 1018 <br /> PANKDESCRIPTION <br /> TANK ID,# 432. 1- 433. TANK CONFIGURATION:THIS TANK IS <br /> IANK MANUFACTURER <br /> 2 1.A STAND-ALONE TANK CouTk4e one page for coch <br /> - OWENS CORNING 0 2.ONE IN A COMPARTMENTED UNIT convortatem in Ifie unit. <br /> TANK <br /> CAPACffY NUMBER OF COMPARTMENTS IN THE UNIT 437. <br /> 20,000 <br /> M. TANK USE AND CONTENTS <br /> TANK USE 0 Ia.MOTOR VEHICLE FUELING C3 1b.M-ARINA FUELING ■ Ic.AVIATION FUELING 439. <br /> 0 3.CHEMICAL PRODUCT STORAGE 0 4.HAZARDOUS WASTE(includes Used CM) rl S.EMERGENCY GENERATOR FUEL[HSC*2528 I.S(c)] <br /> 0 6.OTHER GENERATOR FUEL Q 95.UNKNOWN 0 99.OTHER(Specify): 439a. <br /> CONTENTS PETROLEUM: [3 Ia.REGULAR UNLEADED D IC.MIDGRADE UNLEADED 0 1b.PREMIUM UNLEADED 440, <br /> 0 3.DIESEL 0 5JET FUEL D 6.AVIATION GAS <br /> 0 8,PETROLEUM BLEND FUEL 0 9.OT14ER PETROLEUM(Specify)- 440a■ . <br /> NON-PETROLEIAI'-0-7�-USED OIL 0 .ETHANOL - <br /> -11.OTHER NON-PETROLE IM(Specify): 440b. <br /> IV. TANK CONSTRUCTION <br /> TYPE OF TANK Q 1.SINGL.E:WALL 19 2.DOUBLE WALL El 4i:UNKNOWN 443. <br /> PRIMARY CON MENT 0 LSTEEL 19 3.FIBERGLASS 0 6.INTERNALBLADDE-- <br /> 0 7.STEEL+INTERNAL LINING 0 95.UNKNOWN [3 99.OTHER(SFEiry): 444a. <br /> SE NDARY CONTAINMENT 0 1.STEEL IN 3.FlarRGL-A-S-S 0 6.EX ERIOR MEMBRANE LINER ED 7.JACKETED 445. <br /> [3 go.NONE 0 95.UNKNOWN [3 99.OTHER(Specify): 44 <br /> OVERFILL PREVENTION 0 1.AUDIBLE&VISUAL ALARMS 0- ALLFLOAT C@ 3.FILLTUBEi T-OFFVALVE 452, <br /> REMENTS FOR EXEMPTION FROM OVERFILL PREV ON UIPMENT <br /> VA'0WHA 919,QLexk1X&1vvR11-"v Us - <br /> SINGLE WALL N 2.DOUBLE WALL Q ".OTHff- 460. <br /> SYSTEM TYPE 19 1.PRESSURE Q 2.GRAVITY Q 3.CONVENTIONAL SUCTION [3 4.SAFE SUCTION 123 CCR 11263003)) -458-- <br /> PRIMARY CONTAINMENT [3 1.STEEL 9 4.FIBERGLASS 0 8.FLEXIBLE 0 IQ.RIGID PLASTIC <br /> ■ 90.NONE [3 95.UNKNOWN E] 99.OTHER(Specify)- 464a. <br /> SECONDARY CONTAINMENT 0 LSTEEL 0 4.FIBERGLASS 8.FLEXIBLE 0 10.RIGID PLASTIC 464b, <br /> 0-90.-NONE 0 15.U��NOWN464c. <br /> Q99.OTHER(SpecikL_--- <br /> -PIPING/TURBINE CONTAINMENT SUMP TYPE C1 1.SINGLE WAL 0 90.NONE <br /> !N�GLE WALL0 2. 464d: <br /> VI. VENT,VAPOR i ' 1 1 r r r iCTION <br /> VENT PRIMARY CONTAINMENT [3 1.STEEL 2 4.FIBERGLASS 0 10,RIGID PLASTIC 0 90.NONE [3 99.OTHER(Specify): <br /> VENT SECONDARY CONTAINMENT 0 1.STEEL fig 4.FIBERGLASS 13 10.RIGID PLASTIC El 90.NONE 0 99.OTHER(Specify): 464al. <br /> 464f. <br /> 464fl. <br /> VR PRIMARY CONTAINMENT D 1.STEEL W 4.FIBERGLASS_E3 10.RIGID PLASTIC [3-90.NONE- 13 99.OTHER(specify): 464 <br /> 4641 <br /> VR SECONDARY CONTAINMENT 0 1.STEEL IR 4.FIBERGLASS 0 10.RIGID PLASTIC 0 9D.NONE [3 99.OTHER(Specify).- 4FAR7 <br /> 464hi. <br /> mv <br /> VENT PIPING TRANSITION SUMP TYPE N 1.SINGLE WALL 0 2.DOUBLE WALL 0 90.NONE <br /> RISER PRIMARY CONTAINMENT 0 LSTEEL 9 4.FIBERGLASS 0 10,RIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify)- <br /> 464j]. <br /> RISER SECONDARY CONTAINMENT [1 1.STEEL 10 4.FIBERGLASS 0 10.RIGID PLASTIC 11 90.NONE 0 99.OTHER(Specify): 464k. <br /> 41t411! ' <br /> 1 FILL COMPONENTS INSTALLED CM 4.CONTAINMENT SUMP <br /> VH. UNDER DISPENSER <br /> CONSTRUCTION TYPE 191.SINGLE WALL Q 2.DOUBLE WALL 0 3.NO DISPENSERS 90.NONE 469a. <br /> CONSTRUCTION MATERIAL 0 1.STEEL 4.FIBERGLASS I0.RIGID PLASTIC E3 99.OTHER(Specify) ---r6 97 <br /> 469e.-- <br /> VM. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION Q 2.SACRIFIC 448, <br /> 1X. APPLICANT SIGNATURE <br /> APPLICANT SIGNATURE <br /> APPLICANT NAME(print) JEft LARSEN 471. all <br />