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01/08/2004 08:23 20946834 FIFTH FLOOR PACE =9
<br /> UNIFIED PROGRAM CONSOLIDATED FORM
<br /> S�
<br /> TANKS
<br /> UNDERGROUND STORAGE TA -TANK]PAGE X
<br /> (Two pager per Lank)
<br /> >
<br /> TYPE OF ACTION Er I.NEW PERMIT ❑ 4.AMENDED PERMIT [3 S.CHANGE OF INFORMATION ❑ 6^TEMPORARY TANK CLOSURE 410.
<br /> ((3=k oaa iksn anly) 3.RENEWAL PERMIT __ ____ ❑ 7.PERMANENTLY CLOSED ON SITE
<br /> (Speeifyrea 0 Oomi(yremnn) ® &.TANKREMOV13D
<br /> BUSINESS NAME(Snmeaa PACILITYvrDDA-Da ingBushwz Ag 3. FACILITY ID;
<br /> GTf�S STArT10. l
<br /> Ji Rt.
<br /> LOCATION WITH(N SITE(Optimal) + I.
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<br /> TANK ID 0 432. TANKIC�tSp_
<br /> l�f'UFA�C+TUcRER 433. COMPARTIMENTAI LZED TANK Yea [j No at lµ
<br /> ®07- /` 5IL !r 7 If"Yc"��+Mronepogosbrr�eompaemmrti-
<br /> D•ATE INSTALLED 415- TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS
<br /> (YEAR/MO) 437.A-9 ( $r00o 12, 0oa ,
<br /> ADDITIONAL DESCRIPTION(*b i mo only) 4sa.
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<br /> USE 439. PETROLEUM TYPE 443.
<br /> I.lvjl TOR VEHICLE FUEL ®Ia.REGULAR UNLEADED ❑2.LEADED [j 5. JET FUGL
<br /> fnhewk,mLcompotePetrokaloType) [(Tb.PREMIUM UNLEADED ' DIESEL ❑6. AVIATION OAS
<br /> ❑ 2.NON-FUEL PETROLEUM ®lc. MIDGRADE UNLEADED ❑4. GASOHOL ❑99,OTIIRR;
<br /> ❑ 3. CHEMICAL PRODUCT COMMON NAME(Awa l w=dove Mwwiah lnvemaq page) 441 CASA(from H asduu Cvfafeeuls[mnfory Sage) 4n
<br /> ❑ 4. HAZARDOUS WASTE
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<br /> ❑ 9s.UNMOWN
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<br /> TYPE OF TANS ❑I.SINGLE WALL U3. SINGLE WALL WITH EXTERIOR ❑5. SINQLZ WALL WITH INTERNAL BLPDDER SYSTEM
<br /> (Ckaakl item only) MEMBRANELINER 095.UNKNOWN
<br /> 2.DOUBLE WALL ❑.4.SINGLE WALL IN A VAULT ❑99. OTNE1t.
<br /> TANK MATERIAL-luimery=a„k t.BARK STEL .FIBRRGLASS/PLASTIC IIS.CONCRETE 0,95.UNKNOWN �+
<br /> (clw k ax itcm Ia+U•) C3 2.STAINLESS STEEL II 4. STEEL CLAD W?•IBERGLISS (_(tL FRP COMPATFU.LE Q 99.OTHER.;
<br /> REINFORCED PLASTIC W/100%M7ETTDANOL
<br /> TANK MATERIAL-mondmy tank 1.BARE STEEL . FIMKGLASS/PLASTIC ❑S. FRP COMPTIDLE W/IOD%METHANOL 1:195.UNKNOWN t(:.
<br /> (Check one igm only) ❑2.STAINLESS STEEL❑4. ST63ELCLAD W/FLBERGL.ASS ❑9.FRP NON-CORRODABLE JACKET 99.OT1•IER
<br /> REINFORCED PLASTIC(FRP) ❑10,COATED STM.
<br /> 5. CONCRETE
<br /> TANK INTERIOR LINLN9 Q I.RUBBER LINED 3.EPDXY LINING 5.GLASS LINING 95.UNKNOWN 446. DATE INSTALLT D 44�
<br /> OR COATING. ®2.ALKYD LINING ❑4.?XE NOLtC LIVING ❑6.UNLINED ❑99.OTHER
<br /> Ch-k one.Item on
<br /> OTHER CORROSION 1,MANUFACTURED CATHODIC ❑3.FIBERGLASS REB IFOR CED PLASTIC ❑95.UNKNOWN 44tL DAT13 INSTPJ.LED 4w
<br /> PROTECTION PROTECTION 4.IMPRESSED CMIMT ❑99.OTHER
<br /> afAvolicable) ❑2-SACRIFICIAL ANODE
<br /> SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 4$1, OVERFILL PRO'TECTIO'N EQUIPMENT; YEAR iNSTALLED 451
<br /> (Check all that apply) L SPILL CONTAINMENT �- b;MALARM _C)3,PILL TUBE-,HUT OFF VALVE _
<br /> 7-DROP TUBE 2 BALL FLOAT_©4.EX NFT
<br /> 3.STRIKER PLATE --
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<br /> IF SNGLE„WALL TANKxr 453, r[33.MANUALMON1
<br /> BLE WALL TANK OR TANK W rM 19LA DER 4541.
<br /> (Cloak all"t apply) ow Kam oWy)
<br /> ❑L VISUAL(P_XPOSED PORTION ONLY) ❑S.MANUAL TANK GAUGING(MTG) ISUAL(SINGLE WALL IN VAULT ONLY)
<br /> ❑2.AUTOMATIC TANKGAIIGING(ATO) ❑6.VADOSE ZONE ONTINUOUS INTERSTnMAL MONM)RING
<br /> ❑3.CONTINUOUS ATG E]7.GROUNDWATER ORING
<br /> ❑4.STATISTICAL INVUMRY RECONCILIATION ❑8.TANK TESTING
<br /> (SIR)a BIENNIAL TANK TESTING ❑99.OTHER
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<br /> ED Wnglt
<br /> l; e57
<br /> ESTIMATED DATE LAST USED(YR/MO(DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REM � TANK
<br /> .y..
<br /> '
<br /> ' T MATERIAL
<br /> Yes ❑No
<br /> UPCF hwttwre-b(></99).i14 h1tpt/1www.unidocs cn Rev,02/IQ90
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