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TYAIER RESOURCES CONTR <br /> FORM 'S. �UARD <br /> UNDERGROUND STORAGE TANK PROGRAM <br /> TANK TANK PERMIT APPLICATION INFORMATION <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. <br /> MARK ONLY ❑ I NEWFERMIT ❑J RENEWAL PERMIT CHANGE OF INFORMAnON ,• <br /> ONE ITEM ❑ T PERMANENTLY ClTANK <br /> 2 INTERIM PERA•T AMENDED PERI 0 6 TEMPORARY TANK CLOSURE_ 6 TANK REMOVED <br /> FACILITY/SITE NAME WHERE TANK q INSTALLED•, ! Z <br /> // ARM TANK-YES NO <br /> I. TANK DESCRIPTION COMPLETE ALL TTEMS-IF UNKMOWN=80 SPECIFY <br /> Io <br /> A. OWNER$TANK 10 M <br /> B. MANUFACTURED BV' <br /> C. YEAR INSTALLED <br /> D TANK CAPACITY IN GALLONS: <br /> Ii. TANK CONTENTS IF ill IS MARKED,COMPLETE ITEM C.IF(AT(,IS NOT MARKED,COMPLETE ITEM D. µ <br /> A CO <br /> I MOTOR VEHICLE FUEL 2 PETROLEUM B C <br /> J CHEMICAL PRODUCT ❑�IOP /D ❑ I UNLEADED �Z LEADED �J DIESEL N <br /> ❑ 1 PRODUCT // ❑A GASAHOL El 5 JET FUEL 6 AVIATION GAS <br /> 5 HAZARDOUS ❑ID EMPTY ❑95 UNKNOWN ❑ 2 WASTE ❑ I METHAN L O 99 OTHER(DESCRIBE IN ITEM 0,BELOW) <br /> D. iF NOT MOTOR VEHICLE FUEL,ENTER NAME Of <br /> HAZARDOUS SUBSTANCE STORED 6 CAS.I. /� <br /> C.A.&Ill /3 <br /> .III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A.e,C,A D <br /> A TYPE SYSTEM �2 DOlUBIE WAl1H1 �J SINGLE WAUIDMIN EXTBB'.XIIINFA �95 uww M/ <br /> �O SNXE will A gCO40NCOWAN,ENI �99 OGER <br /> & TANK �S ISTEHZION El2STANESSST� 391PEFMA55 ASIEB DAD wRBER2ASS11EN'OIIC®PLASIIO <br /> MATER ❑6 F fE El f PoLTYNYL owl /ALUMINUM •10991E71WOL WMpATIBE iW <br /> 0 9 BRONZE N GALYANZ®SIFB %LN KNOWN IS ma <br /> C. INTERIOR ❑ 1RA3emul 02AIMLNNG JEPO%Y KINKING INENOIX:WNc <br /> UNI //_ ❑9 GLASS LPaU i IIa•IBI El 9S INSIOMN <br /> YJ ❑SIHIC W769A1001PATIREYA1N 100a MERW10l �- YES ❑Np ❑99one <br /> D.CORRIOSI I POUEDLIKIIy 02 TAR OR A$PIMU El 3 VINYL ll O A RBBT2ASSIE•IOIX�IIAST1p <br /> PROTE �S CATICOICPpDTECiOII „IIOtE EJ 95me WN ElHOR61 <br /> IV. PIPING INFORMATION CWCLE A FABOVEGF-(XM. U IFU"RouND,BOTHrAPruCAaLE <br /> A SYSTEM <br /> 112MILV A U I RUCTIONA U 2 pRESSIURE A U 30M A V BOTHER <br /> S. A U I SINO E WALLED A U 2 DOUBLE WALLED A U 3 UNEDTRENOA A V M UNKNOWN A U 99 OTHER <br /> F A U I SIEB/EON A Y 2 STAINIESSSI A U 3 POLY VOMO LONDE(PYLT A U A RBEFOLASSpIPE <br />. C. WTEAUL ® A U 6ALLKNAUM A U 6CONCRETE A U TSTEELCLADW/RIP A U 9100% <br /> A U •GALVANZEDSTE73 A U 95 UNKNOWN METHANOL COMPATIBLE RP <br /> A V BOTHER <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY OR S FOR SECONDARY A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> (��/ 1 VISIAAL CHECK ► • 2 INVENTORY REO0HC0.IATKIN P • 3 VADOSE WELLS r • A ELECTFIDMC M0,i P • 6 <br /> ��j B PAEC!&ON TESTING • • 9 ORDUHO WATER MONITORING WELLS <br /> PRES6TXIE 7ESnrO ► • 91 HONE r • 96 IMCKOwN P • BOTHER <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> I MATED DATE LAST USED(MGfA:q ST illOUANTm OF <br /> t/ �E RE��IN TANK(E0.LEp WITH <br /> QALLO• MATERIAL? YE$ NO <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. <br /> APPLK,AFD`•NAME MWI•BONAYLI GATE <br /> LOCAL AGENCY USE ONLY <br /> • �`, <br /> AGENCY rum '� FACILITY ID r Z TANK(ID I <br /> wCAL A0E9Ic.r!O.TTY a 1 fy ME PHOAN I WITH ANA COOS <br /> f�Lw <br /> PWdWETTRATWODATE <br /> -- 3 o <br />