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UNIFIED PROGRAM CONSOLIDATED FORMTANK6( UNDERGROUND STORAGE TANKS - TANK pAGE 11'/� TYPE OF ACTION (Two pages per tank) ❑ L NEW PERMIT ❑ 4.AMENDED PERMIT _ (Chttk one item only) ❑ 5.CHANGE OF INFO Page_of ® 3.RENEWAL PERMIT INFORMATION ❑ 6.TEMPORARY TANK CLOSURE - 430. BUSINESS NAME Same (SPttify recon) ❑ Z PERMANENTLY CLOSED ON SITE ( u FACILITY NAME cr OBA- (SIwiryncamn) R der Trans Ortation Services#1071 Wmg ElWra,Aa) 3 FACILITY ID: IJ S.TANK REMOVED LOCATION WITHIN SITE(Opd°naq 1 3633 Duck Creek Drive 431. (A scaled plot plan with the location of the UST system includi g buildings and andmarks shall be submitted to the Iocal agency,) TANK ID# �y (� /' 432. the MANUFACTURER 2 A ED U� 431 COMPARTMENTALIZED TANK E]Yes ® No DATE INSTALLED Tmsco 435. TANK CAPACITY M GALLONS If"Yes^m Inc nne 434. 10/31/199 R Page for each CENTS rnt 10/31/1990 41fi' NUMBER OF COMPARTMENTS ADDITIONAL DESCRIPTION(For tical uc oNy2,000 437 438 TANK USE 439 II. TANK CONTENTS PETROLEUM TYPE ® 1. MOTOR VEHICLE FUEL (Ifchecked,mmpleta Pcmleum Type) ❑Ia- REGULAR UNLEADED449 ❑2. LEADED [15. JET FUEL ❑ 2. NON-FUEL PETROLEUM ❑16 PREMIUM UNLEADED ®3. DIESEL ❑Ic. MIDGRADE UNLEADED ❑9 AVIATION GAS ❑ 3. CHEMICAL PRODUCT ❑4. GASOHOL ❑99.OTfiEA: COMMON NAME (E,m Hazardau Muciats Inwnlo ❑ 4. HAZARDOUS WASTE ryPage) 441' CA$#(from Hazardous Malenals lnvcmory page) qqZ, (Irclades Used Oil) ❑ 95.UNKNOWN TYPEIII. TANK CONSTRUCTION OF TANK ❑1. SINGLE WALL (Check one item only) ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH B4TERNAL BLADDER SYSTEM 443. ®2. DOUBLE WALL MEMBRANE LINER ❑95. UNKNOWN TANK MATERIAL-primary rank ❑1. BARE STEEL ❑4. SINGLE WALL M A VAULT ❑99. OTHER ®3. (Check F®ERGLASS/PLASTIC ❑5. CONCRETE "ae nem°nly) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑95.UNKNOWN 444 REINFORCED PLASTIC FRP ❑S. FRP COMPATIBLE ❑99.OTHER: iANK MATERIAL-secondary tank ❑I. BARE STEEL ®3. FIBERGLASS/PLASTIC W/100%METHANOL (Chack one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑9. FAP NON O 0 NOL [195.UNKNOWN 445. RRODABMC� REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑99.OTHER TANK INTERIOR LINING ❑1.RUBBER LINED ❑5. CONCRETE OR COATING ❑2.ALKYD LINING ❑J.EPORY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446, DATE INSTALLED 447. Check one item only) ❑4.PHENOLIC LINING ❑6.UNLINED ❑99.OTHER OTHER CORROSION ❑L M i NUFA�MREDCATHODIC ®3.FIBERGLASS REINFORCED PLASTIC Cl 95,UNKNOWN 448, DATE INSTALLED 449, PROTECTION PROTECTION ❑4.IMPRESSED CURRENT If A bcable) ❑2.SACRIFICIAL ANODE ❑99OTHER SPILLAND OVERFILL YEARINSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEARINSTALLED (Chmicallthatapply) ® 1.SPILL CONTAINMENT _1990 452.®1 _ ❑2.DROP TUBE1.ALARM ®E ❑ 1BALL FLOAT 3.FILL TUBESHUT OFF VALVE_1990 ❑3.STRIKER PLATE . ❑4.EXEMPT IV.TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK (Check all that apply) 453- IF(ChDOUBLE WALL TANK OR TANK WITH BLADDER 454- ❑ I. VISUAL(EXPOSED PORTION ONLY) k One item only) ❑5.MANUAL TANK GAUGING(MTG) ❑1�VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE ®2.CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUS ATG ❑7.GROUNDWATER [14. STATISTICAL INVENTORY ❑3.MANUAL MONITORING RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE WFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? d5]. gallons ❑Yes ❑ No UPCF hwfwm-b(V99).1/4 www.uni&(!Lorg Rev.07/16/00