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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> ftwp pages per Mnk) <br /> Page _ of n.. <br /> TYPE OF ACTION ❑1.NEWSITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGEOFINFORMATION) ❑8.TEMPORARY SITE CLOSURE <br /> rCNck am Nate.,W,) 3.RENEWAL PERMIT T. PERMANENTLY CLOSED ON SITE <br /> OM1? (SpecifycMnpe-fwbwu»onlN �aJ 8. TANK REMOVED 430 <br /> BUSINESS NAME ISwoe ea FACILITY NAME w DBA-Doinp Buaineaa As) FACILITY ID N 1 <br /> 05P.5 v N GI 1 I <br /> LOCATION WITHIN SITE(OPh'orwp 431 <br /> 1.TANK DESCRIPTION <br /> TANK IDM TANK MANUFACTURER COMPARTMENTALIZED TANK ❑Yea No <br /> 1 151 Lk -O If'vaa',c Plate o Page rw exh romParoMM. <br /> DATE INSTALLED(YEARMMO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> ADDITIONAL DESCRIPTION IF.fecal uae wW) <br /> II.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> ❑ 1. MOTOR VEHICLE FUEL ❑te. REGULAR UNLEADED 11 2. LEADED ❑ 5. JET FUEL <br /> (pma 'CO-PlaM PeNlswn Type) 11 MD. PREMIUM UNLEADED ❑ 3. DIESEL 11 8. AVIATIONFUEL <br /> 2.NON-FUELPETROLEUM 111c MIDGRADE UNLEADED ❑ 4. GASOHOL 11 N, OTHER <br /> ❑ 3. CHEMICAL PRODUCT <br /> ❑ 4. H RDOUS WASTE(latlutles COMMON NAME ff.HuaN Matenala lnrenforyppe) CAS 0 if.Hua Now Merenels kt.n ,pe9e) <br /> Uaed Oig <br /> 1N 1 W.TANK CONSTRUCTION <br /> TYPE OF TANK 17 1. SINGLE WALL 113. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Cha&"gem only) 2, DOUBLE WALL EXTERIOR MEMBRANE LINER 1195. UNKNOWN <br /> 11 4. SINGLE WALL IN A VAULT 1198 OTHER <br /> TANK MATERIAL-PMmery Mnk t BARE STEEL 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE 1195. UNKNOWN <br /> (C/rock orfs item only) ❑ 2. STAINLESS STEEL ❑4. STEEL CLAD WNIBERGIASS ❑ B. FRP COMPATIBLE W/100%METHANOL ❑N. OTHER <br /> REINFORCED PLASTIC FRP <br /> conda <br /> TANK MATERIAL-sery Jar* 111 BARE STEEL 3. FIBERGLASS/PLASTIC ❑ 8. FRP COMPATIBLE W1100%METHANOL 095. UNKNOWN <br /> (CNck.demonry) 11 2. STAINLESS STEEL ❑ 4. STEEL CUD W/FIBERGLASS ❑ 9. FRP NOWCORRODIBLE JACKET ❑N. OTHER <br /> REINFORCED PLASTIC(FRP) []10 COATED STEEL <br /> ❑ 5. CONCRETE <br /> TA COATING COATING LINING 0 1, RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS UNING 095. UNKNOWM433 GATE INSTALLED <br /> OR <br /> ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ e. UNLINED ❑99. OTHER <br /> (Check.Nm oo (Forlocal use only <br /> OTHER PROTECTION <br /> IF ON [] 1 MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 431 DATE INSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> (CNck one dem onW ❑ 2. SACRIFICIAL ANODE 4. IMPRESSED CURRENT W. OTHER (FwbcM use onN <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(FwkrMuseo*) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Check epfMt apply) ❑ 1. SPILL CONTAINMENT <br /> ❑ 1.ALARM 3, FILL TUBE SHUT OFF VALVE <br /> 11 2. DROP TUBE 13 2. BALL FLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> IV. TANK LEAK DETECTION <br /> IF SINGLE WALL TANK fCld ed Mat apply): IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only) <br /> ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 8. VADOSEZONE ❑ 2. CONTINUOUSINTERSTITIALMONITORING <br /> ❑ 3. CONTINUOUSATG ❑ T. GROUNDWATER ❑ 3. NANUALMONITORING <br /> ❑ 4. STAMSTICAL INVENTORY RECONCILIATION(SIR) ❑ 8. TANKTESTING <br /> BIENNIAL TANK TESTING 090_ OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRIMO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 1 TANK FILLED HATH INERT MATERIAL? <br /> eelona ❑Yee ❑Na <br /> CUPAFORM(4/99) Formerly SVVRCB Form 8 <br />