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Jun 18 08 06:52p Allen Thomas 530-622-2275 p.10 <br /> !1/�'LJ �e�ycrJV'��� Noci�n/Gc c7F�NFc��!-�7o.cJ <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-TANK INFOR1144,TLON(Oac mem P�usT) <br /> TYPE OF ACTION (Click one item only. Foran USTPetmaoeat chane em <br /> wrevaia,w1Pk only d1is eod S=b=S C 1T.IQ IV,and IX hdow up <br /> ❑ 1.NEW RG141' ❑ 3.RENEWAL PERMIT IFF <br /> CHANGE OF INFORMATION m9 nlrlf& „ <br /> 6.TEMPORARYUSTCLOSURE 7.USTPERMANENTCLOSUREONSR'E FUST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: - DATE k7IRITAIG UST DISCOVERED: 4lon <br /> I. FACQITYINFOR11fATION.. . .. . <br /> FAClL1TY 1D k(Ageery Ute O,dyj <br /> _ I <br /> BUSINESS LlA (Sameas FACILITY NAME oTDHA-Doing ausia=As) 3 <br /> Dors L� ��N�12 <br /> BUSINESS SITE ADDRESS Im Cf1'Y la <br /> [L TANKON. <br /> TANK mp 4R TANK MANUFACTURER 'OI TAMC CONPIGIIRAT30N:TRIS rANK IS - 43 <br /> LASrANO-AwNETANK <br /> ) �N 2CYiE IIfACdRARtT�MFD Utdr. <br /> DATE USF bx b l 3 INSTALLED 4u TANK CAPAC(I'Sj IN GALLONS 436 <br /> 19 NUMBER OF COMPARTAgTlIS IN THE UNIT ar <br /> 4Y <br /> TIL TANK USE.AND.CONTENIS' <br /> TANK USE Ia MOTOR VERICfF FUELING ❑ 14 MARINA RIFLING ❑ Ic AVIATONF'Ut2.QiG G9 <br /> 3.OTHEKCHEMICAL NRATOR STORAGE ❑ 4.Hg7JUtDOUS WASTE OegmetlLd[00 QxIDtFRGENCYGENERATOR FUEL Dt9CfxastsldI <br /> ❑6.OTHER GENERATOR FUEL Q 95.UNKNOWN ❑99.OLE1IIt k 419a <br /> CONTENTS P£IROI,EDM; '�Ia REGULV(UNLEADED 01.E@X'RADE UNLEADED ❑ Ili PRELIM M UNLEADED 4q <br /> ❑ 3.DMSEL Q S.IETFUPL Q&AVIATON GAS <br /> ❑ &PERtOLELRM BLEND FTmr Q 9.ODDRPETROLEUM ype <br /> NON-PETT<oceuM:Q�.usED on. ❑ 10.ETRANIOL <br /> 13 1 L OTihA NON-PETROLEUM 4� <br /> - - IV. TANK <br /> TYPE OFrwNK t MUM WAI DOUBLE WALL 9s.udlnvowt4 <br /> ,j,l PAALARY COMAWMENr ❑ LST W 3.FIBEAGLASS 5,WrERNALBLADDER <br /> J' ❑ T.STFE7,e iNTERNAI,LINDIG <br /> SECONDARY CONTAINMENT ❑95.UNI010WN 9p.OTiRR 4� <br /> Q 1.5147. 3.FBFEG[A5$ ❑b.EXIER10R a/EMHRRANR LO'!E]L ❑7.JACXETED at£ <br /> j ❑ 90,NONE 9J.UNKNOWN ❑99.OTIffiC 441a <br /> OVERFRI,PREVENTION I,A[RIIBLE$VISUAL ALARMS 2BALLFLOAT 3.F7LLTUBE SH[J[-0FF VALVE � <br /> ❑4_TANKMFtTS AEQUMMAM$FOMtMMMPTIONMOMOYEAFBLPRSyENTMN UIPMFM' <br /> . V. PRODUCT l:WAMPIPING <br /> CpN58'RUCTION <br /> PIPINGCONISIRUCTDN ILSINOL6wALrED DOUBtEwAum 99.ono-x <br /> SYSTEM TYPE I.PRFSSIfRE 2GRAVITY (]3.CONYF7f17ONAL.SUCTON 4.SAFES .. . <br /> PRIMARY CONTARRIENI' UCDON CMpfi ( OB <br /> .STEEL 4.FiBHIGLASS &'LEXIII F 1U.RIGIDPI.ASTIC w <br /> ❑9Q NDNF 9S.WJRNOWN Q 99. ibh <br /> SECONDARY COMAINMFNI' F.STEII. .FWERG i.Fl error e Q I O.RIGIDPLASTIC 4tMt. <br /> ❑W.NONE ❑95.UNKNOWN ❑99.OTTRR( <br /> PIP(NGII'URHINE CONZA[NMENTSUMPTYPELSINCLEWALL Q 21)QURLB WALL 90_tfONE <br /> VL VENT,VAPOR-RECOVERY(VR)""WISMIFUAPLEE-PI INGG©NISTRUCFION. - . . . . <br /> VENT PR[MARY CONTAINMENT 1.S7EEI. 4.ETBERGIASS l W KIU PLA3ITC 90.NONE 99-OWER(Spore,) I64e <br /> VENT SECONDARY CONTAINMENT LS1EQ. 4.FIBERGLA'S Q 30.RIGID PLASriC 461et <br /> 90.NONE 49.OFFffR(SpeeQy) ,UF <br /> VR PROMARY CONTAINMENT I.STEEL 4.FIBERGLASS 0 10.RIGID PLASTIC 90.NONE Li 99.OT)lER lSppoTy) 454a <br /> VR SECONDARY CONTAINMENT ❑ t.STEEL4.HE it i11S5 10.RIGID P[ASIIC 9Q NONE 99.ODlFA.iSpeody) ,Kq <br /> V T PINNG TRANSITION 5U61P TYPE 1.SINGLE WALL 21XR18LF WALL 90.NO <br /> 4681 <br /> R6FRPRIMARV CO)TfA1N'NDNi 1.STEEL 4.FMERGLASS IO.RIGIDPLASTIC U 90.NONE 099.OIIER(Spdy) 45§ <br /> RISER SECONDARYCOMAINMEM I.STEE3. 4.p®p.RGLASS IA RIGO PLASTLC �l <br /> 90.NONE 9S dilm[(S�ec%) 461t <br /> FILL COMPONENTS I1STAtrm I.SPILL BUCKEr 3.STRIXFA PLATFIBO'rrOM PRD7'ECILRC 4.CONTA1 MSNT'SEW a3�1 <br /> VIL UNDERR LKSPENSER:CONrAINMENT(ODGj <br /> CONSTRUCTION TYPE 1.SINGLE WALL, ❑2 DODBLE WALL Q 3.NO DSPQISERS <br /> CONSTRUCTOON MATERIAL _ I.STEEL ❑4.F®ERGLISS ❑ 1&RNID PLASTIC ❑ 99.OI7D1C Q 90.NONE <br /> VIII. C(11RROSI(NPROTECTLON <br /> STEEL COMPONENT PROTECTION ❑ i SACPJFTCIAL ANODF{S) 0 4.IMPRESSED CURRENT Q 6.ISOLATION SIS. <br /> IX: APPLICANT SIGNATURE <br /> CERTIFICATION_ I ce y Wu Ihil UST IYOM is wm)ndile with the hunrdms ruhataace cored and drat the 6formadw)nurided hetria h . . <br /> and in full wm 16xe wkh a[ ,t1mm nb. ftoy aecaraty <br /> APPLICANT SIGNATU DATE 4n <br /> l dri 6' 2 <br /> APPLICANT NAME(print) � 4n. APPLICAM'TrILE ,^ as <br /> UPCF UST-R-112 <br /> Rev.(12COM <br />