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. 01/08/2004 08:23 2094683n* FIFTH FLOOR PAIGE :_9 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STQRAGE TANKS-TANK PAGE 4 �/ (Two pages per tank Page -of IZ TYPE OF ACTION 1,NEW PERMIT ❑ 4.AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6 TEMPORARY TANK CLOSU RE 4:10• (Chcck one ioxn aaly) ❑ J.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify 8.TANK REMOVED BUSINESS NAME(Sameae PACILITYNA?M xDBA-Daingllmh ss A3) 3. FACILITY ID: "S STArTI 0 N ,111,1, LOCATION WITHIN SITE(omional) -- a 11 i11, '1, ! , : I 11"l'.1.11\lt'DE5CYl17► ON' 1 ( �';1 ' I,11 1 r'T l l 1• 11 1 fll 1'i• SI I!1 1... 1 1 li 1 1 1 ' � I 1 Ai�ctllodlPlot.plan With;the lcuaYtort oEt�e USi sytitom iincludingbllttdleQS'Atld landtt>ykslShtilCbehab8itt&461hc lata]agency!), TANK ID 01,n �/ ./ 432 TANK MANUFACTURER 433• COMPARTMENTALIZED TANK Yes No Z77V 1 f lB A G IL x F S If"Yes"corTIme one paae lbr eoch eamport=re. DATE INSTALLED 435• TANK CAPACITY IN GALLONS 436. NUMBER OF COMPAKTMENTS (YEAR/MO) 4J7, A?Px 05 Zoo Zo, 60 I ADDITIONAL DESCR N ul,ri.i ase aay) Nae, 30n: in I O I"Al�i GON EFTS ' �,�u•..0 1 11..•, ! I 1 I rra11 I! u n'r, TANK USE 4"- PETROLEUM TYPE 443, J. MOTOR VEHICLE FUEL �1a. REGULAR UNLEADED ❑2. LEADED d 5. JET FUEL pfahecked,conpleta PHroteumTro�) ❑16. PREMIUM UNLEADED [33. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑le. MMGRADE UNLEADED ❑4. GASOHOL ❑99,OTHER; _ ❑ 3. CHEMICAL PRODUCT COMMON NAME(from Ha r&m Materuts lavatory page) 041' CAS#(from Hazrrdous M:rlerials Iavealory loge) --dtl:: ❑ 4. HAZARDOUS WASTE (lnclvdca'Acd Oil) ❑ 95.UNKNOWN uq u NIf 11 DX N CONSTR�JCTION ; i 'I' "; TYPE OF TANK ❑1. SINGLE WALL D 3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 44? (Chock otic itemonly) MEMBRANE LINER ❑95. UNKNOWN 2.DOUBLE WALL ❑.4. SINGLE WALL IN A VAULT ❑99. OTHER. TANK MATERIAL-primarywrk U71.BARE STEEL X3.FIBERGLASS/PLASTIC 0 5. CONCRETE ❑95.UNKNOWN 444_ (Gr1ak ont item only) ❑2. STAINLESS STEEL [14- STEEL CLAD WIFIBERGLASB ❑S. FRP COMPATIBLE ❑99.OTHER; REINFORCED PLASTIC W/100%MET11ANOL __ TANK MATWAL-secondary tank 1. BARE STEEL FIBERGLASS 1 PLASTIC ❑8. FRP COMPTIBLfi W/IOOY METHANOL ❑95.UNKNOWN 44:. (Check one item only) ❑2. STAINLESS STEEL[14. STEEL CLAD WRIBERGLASS 0 9.FRP NON.CORRODABLE JACKET )]99.OTHER_---_ REINFORCED PLASTIC(FRP) ❑10.COATED STEEL S. CONCRETE TANK INTERIOR LINING ❑1,RUBBER LINED LI 3.EPDXY.LINING S.GLASS LINING 93.UNKNOWN 446. DATE N STA,LLl-6_a47_ OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING ❑6.UNLINED ❑99-OTHER Check onc,item only) OTHER CORROSION 0 1.MANUFACTURED CATHODIC ❑3.FIBERGLASS RL^BVPQRCED PLASTIC Q-ffVNKNOWN 448. DATE INSTALLED 449 PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER afAgolicabic) ❑2..SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 431, 13VARFILL PROTECTION EQUIPMENT; YEAR INSTALLED 45•l (Cbeck till that apply) g L SPILL CONTAINMENT y00 t1 1.ALARM _❑3.FILL TUBE;FHT OFF VALVE---_ 2_DROP TUBE _t4- 2.BALL FLOAT_©4,EXEMPT 3.STRIKER PLATU T I�L'•EAK CTI N - � �AN � � o 1 I ., 1 - • . ! , 1 .� 11.I�1 �',if 1 11 1 1 1 •, •11 1 1 :dt 1 11 1 ! u 1 1 1� pa 1 f�. ,,; •'1n2 CIY•ot,th�motlltor3 ro sl►allbesabmt to'Ih eco! en IF SINGLE WALL TANK 453. 11 DOUB WALL TANK OR TANK W[TIi BLADDER�454 (Check all O1at apply) (Check oce i only) ❑1.VISUAL(EXPOSED PORTION ONLY) [35.MANUAL TANK GAUGING(MTG) ❑I.VISUA (SINGLE WALL IN VAULT ONLY) ❑2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSA ZONE ❑2,CONT VOU$NTERSTITIAL MONITQRING ❑3.CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MAN AL MONITORING ❑4.STATISTICAL N VL•NTQRY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING . ❑99,OTHER l„ 1 1�.1,,...• „ 1 ,n1 �CV TAN�C 1n. n1 ESTIMATED DATE LAST USED(YRtMO/DA-0 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? 457 p1lo a ❑Yc3 ❑No UPCF hwfwrc-b(1199).114 http:11Www.anitbca.0rg Rev.02:116100