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UNIFIED PROGRAM CONSOLIDATED FORM 7PqT4o TANKSUNDERGROUND STORAGE TANKS - TANK PAGE tank) ENge-of_ TYPE OF ACTION 1.NEW PERMIT ❑ 4.AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMP 0. (C6mkam eao only) ❑ 3.RENEWAL PERMIT 07.P HRMANENTLY C A9 (Spcifymama) (Spac'fr'®'o°) ❑ 8.TANK REMOVED BUS SNAM (sem,m FACILITY Nwtd ar BA-ookg Euemcm as) 3. FACILITY ID: I. A n S1 , a 56'16 / LOCATION WITHIN SITE( ) SouS12- I S. C-�2R ©� P �L:' Oat. L.TANKDESCRIPTION- (A,scaled: I tp)an with the Iorattonof[he UST st-stem mcludinK 6uildmgs and landmarks shall'.be submitted to the local agedcvJ TANK ID# 133- TANK MANUFACTURER 433_ CONIPARTMENT.ALIZED TANK ❑Yes �'No 434. oS/573-7 un ,�aa If"Ye;"mnpbm me page 6r culccmammmt DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS (YEAR/ w �OO NA"' an. ADDITIOANSDESCRIPTION fticcal,ue adr) f II..TANK CONTENTS- TAyKUSE 439. PETROLEUM TYPE 1r�'/1. MOTOR VEHICLE FUEL J-�/la'. REGULAR UNLEADED pfchalal,w�be PeOolavn Type) ❑2. LEADED C1 5. JET FUEL C1 11c. PREMIUM UNLEADED ❑3. DIESEL ❑,6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99,OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Emu mms mumuh Iwmtary page) 441. CASfk(ham tivarmm Mmveh Ivvemorypage) "z ❑ 4. HAZARDOUS WASTE (kc4edn U d a0 ❑ 95.UNKNOWN Cnp.s III.TANK CONSTRUCTION TYPE OFTANK 1. SINGLE WALL E-13, SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 4a3. (CSeck oneitemonly) MEMBRANE LINER 095. UNKNOWN DOUBLE WALL 4. SINGLE WALL IN A VAULT 99. OTHER TANK MATERIAL-pnmvry mvt . BARE STEEL 3. FIBERGLASS/PLASTIC 05. CONCRETE El 95.UNKNOWN aas. (Cbeelt om acm amy) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGEASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC W/100%METHANOL TANK MATERIAL-secondary tack , BARESTEEL ❑3. FIBERGLASS/PLASTIC El 8. FRP COMPTIBLE W/IWA METHANOL El 95.UNKNOWN -5. (Check oro item aoly) [12. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS [19. FRP NON-CORRODABLE JACKET [199.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR(LINING 1.RUBBER LINED LJ 3.EPDXY LINING L3 5.GLASS LINING D 95.UNKNOWN 9e6. DATE INSTALLED a7. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING r6.UNLINED ❑99.OTHER Cheek one ikm oW OTHER CORROSION M L MANUFACTURED CATHODIC 3.FIBERGLASS REINFORCED PLASTIC95.UNKNOWN ma. DATE INSTALLED 449. PROTECTION PROTE70N ❑4.IMPRESSED CURRENT ❑99,OTHER If licabk 2.SACRIF CIAL ANODE �n SPILL AND OVERFILL YEAR INSTALLED 450. I TYPE 451. 1 OVERFILL PROTECTION EQUIPMENT: YEARINSTALLED 452 (Check all that apply) ❑1.SPILL CONTAINMENT ❑I.ALARM ❑3.FILL TUBE SHUT OFF VALVE ❑2.DROP TUBE ❑2.BALL FLOAT_ ❑4.EXEMPT ❑3.STRIKER PLATE I!A k/bEh1y7 IV.TANK.LEAK.DETECTION. - (A description of the monitoring progr.vn shall be submitted to the local agency.) IF SINGLE WALL TANK 453, IF DOUBLE WALL TANK OR TANK WITH BLADDER 454, (C k all that apply) (Check ms item oNy) 1.VISUAL(EXPOSED PORTION ONLY) ❑S.MANUAL TANK GAUGING(MTG) ❑I.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE [12.CONTINUOUS INTERSTITIAL MONITORING [13.CONTINUOUS ATG ❑7,GROUNDWATER [13.MANUAL MONITORING ❑4.STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE'INFORMATION/ PERMANENTCLOSURE IN PI ESTIMAT/E�D DATE fLcAST USED(YIP MO/DAY) 455- ESTI/� TED QUANTITY OF SUBSTANCE REMAINING 4$fi TANK FILLED WITH INERT MATERIAL'? 4$7 t(© J e/ gallons ❑Yes xNo UPCF hwfwre-b(1/99)-1/4 http://wway.unidoes.urg Rev.02/16/00