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MAR. 1. 2010 9:40AM AGQPANOS JET CTR . NO. 689 P. 4 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(Ow form pa UST) TYPE OF ACTION (Check one itom only. For an UST permodenl closure or removal,complete only Ibis section and Sections 1.1a III,IV,add IX below) M13a C31,'."Q& 3.RENEWAL PERMIT ❑ 5,CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE Q S.UST REMOVAL DATE UST PERMANENPLY CLOSED: 4 DATE EXISTING USTDISCOVERED: 4'°e T. FACEUTV INFORMATION FACILITY ID#(Agency Use Only) _ 1 BUSINESS NAME(Same so FACILITY NAME or DBA-Doing Business As) //�1 / 3 BUSINESS SITE ADDRESS yqOe � ClY <4 oc%-Eo1J I04 IL TAWK DESCRIPTION TANK IDk �•a4� G L 432 TTANK ACTURER /f4A TANK CONFIGURATION; THISTANKIs 434 ✓ Y 'r/Iffr Cs/I�A4�A r31��3L �1.A STAND-ALONE TANK /� 3.ONEINACOMPARTMENEDU,`IT. ("� J/Dv e. eorc bf eYJl gainik DATE UST SYS' TED Us TANK C ✓ AP IT f,OQALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT / 437 III ANKUSE AND CONTENTS TANK USE ❑ Io.MOTORVEHICLE FUELING ❑ Ib.MARINA FUELING Mto.AVIATION FUELING 439 ❑ 3.CHBMICALPRODUCT9TORAOE [34.HAZARDOVSWASTB(Wd U4e30d) U S.BMBROBNCY GENERATOR FURL BLOC 6MIL3(0) 13 B.OTHEROENERATORFUEL 13 95.UNKNOWN 99.OTH1Ei S 439° CONTENTS P3T1(OLEUM: i] In.RRGULARUNLBADBD to,MIDORADE UNLEADED ❑ Ib.PREM3UMUNLEADED Mo ❑ 3.DIESEL S,YET RM ❑ 6.AYIATIONOAS ❑ B.PETROLEUM BLEND FUEL 139.OTHER PETROLEUM 9191 NON.PETROLE11W❑ 7.USED OIL fa l0.ETHANOL 0 ILOTHERNON-PETROLEUM 3 440b IV, TANK CONSTRUCTION TYPE OF ANK C31,SINGLE WALL 2.DOUBLE WALL 96.UNKNOWN 443 F(UMARYCONTALWIENT U LSTEEL 3.F159INTERNAL 6.INTERNAL BLADDER 499 [37.STEEL+ANTE LLTNINO 95.UMINOWN C3 99.OTHER 3 e : 4443 SECONDARY CONTAINMENT I.STEEL .FIBERGLASS ❑ 6.EXTERIORMEMBRANBLINBR ❑ 7.3ACKETED 4u 90.NONE 95.UNKNOWN EI 99.OTHBR S ws° OVERFILL PREVENTION 1,AUDIBLE A VISUALALARM9 ❑ 2.BALL FLOAT 3.FILLTUBa SHUT-OFF VALVE 452 4.TANK MEETS RE UMEMENCS FOREXEMPTION PROM OVERT LPRBVHNPLONE UIPMBNT V. PRODUCT/WASTE PIPING CONSTRUC'T'ION PIPLNGCONSTRUCDON I,SINOL&WALLED 2.DOUBL&WALLED 99.OTHEIt am SYSTEM TYPE 1.PRESSURE .GRAVITY 2.CONVENT ONAL SUCTION [34.SAFE SUCTIONF23 CCR 83 3 3 4% PRIMARY CONTAINMENT U I.STEEL 15 4.FIBERGLASS ❑ S.FLEXIBLE ❑ I0.RIGID PLASTIC 461 ❑90.NONE ❑ 95.UNKNOWN [I 99,OTHERS Ify): 4643 SECONDAAYCONCAINMENT I.STEEL F4.FIBERGLA53 U a.FLEXIBLE ❑ Io.RRNPFLASTIC 461! E]90.NONE ❑ 95.UNKNOWN ❑99.017HER Spec' : osla PIPINOITURBINS CONTAINMENT SUMP TYPE 1.SINGLE WALL 2,DOUBLE WALL 0 90.NONE 46(0 VL VENT VAPOR.RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT Lj 1.STEEL QR 4.FIBERGLASS U IO.RIOTOPLASTIC 90.NONE C3 99. It apealgi 444° 96b1 VENT SECONDARY CONTAINMENT E3 I.STEEL U 4,FIBERGLASS ❑ IO.RMIDPLASTIC It 90.NONE ❑ 99.OTHER(Spee1G.) 404f 411411 VRPRMMYCONTAINMENP U 1.STEEL %4.ITBBROLAW Q 10.RIGID PLASTIC ❑ 90.NONE ❑ 99,OTHER(SpccHY) 4618 3 I VR SECONDARY CONI•AINMBKT ❑ I.STEEL ❑4, IBEROLASS 0 I0.RIGID PLASTIC 90.NONE Q 9%OTHER(SPOW) 4441 464M VENC PIPING TRANSITION SUM TYPE 0 1.SINGLE WALL 0 2.DOUBLE WALL 90.NONE 4611 RISER PRIMARY CONTAINMENT 1.STEEL 4.FIBERULASS 10.RIGID PLASTIC 90.NONFi 99.01HER(S*0. ) °61i 1 RISER SECONDARY CONTAINMENT U 1.STEEL Q 4,FIBERGLASS 10.RIGID PLASTIC IN 90.NONE 0 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED I.SPILL BUCKET 3.STRIKER PLNIEMM70M PROTECTOR U 4.CONTAINMENT SUMP 451" VH.UNDERDISPENSERCONTAINIDIENT UDC) CONSTRUCTION TYPE ❑ !.SINGLE WALL ❑ S.DOUBLE WALL 9.NO DISPENSERS 90.NON8 449¢ CONSTRUCTION MATERW. LSTEEL 4.f7EBROLASS U10.RIOm PLASTICQ 99.OTHER e) 4696e VM,CORROSION PRO'T'ECTION' STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIALANODE(S) E3 4.IMPRE838D CURRENT ❑ 6.ISOLATION 448 DK. APPLTCANTSTGNATURE ' C6R ICATION;I certify that this UST system is compadblo with the haaudous substauea stored sod that the Information provided herein is true,accurate, and In NE com c wiflOccal re plrements. 1 yf,A7(ptyA n6 DATE _ I f 1 470. ApPI.[CANII WIN• tL)1LY/7•• 4" APPLICANTTITLI3 "i�f /. C y( UPCBUST-B_-1/3r \ �/� �l /Hev.(12/2007)