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JAN -29-2013 13:17 <br />Frbm:2092347295 <br />PaB X14 <br />AAA <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />UNDERGROUNDSTORAGETANK !, 2 <br />OPERATING PERMIT APPT.TrATrom _ TAMY rx noAa A'T'Fnwr • _S) <br />TYPE OF ACTION (C'bwk Ono IBM and F UST pammem ckmmc or mmovg CoMlde only mu Teetim ad so= 1,and <br />❑ 13 <br />I. NEW PERMIT 3. RENEWAL PERMIT ❑ 5. CHANGE OF INFORMATION <br />6. TEMPORARY UST SURE 7. UST PIMMANENT CLOSURE ON SITE REMOVAL <br />MAIL <br />GATE UST PERMANEN[LYCLbSFO; DATE EX(STING LIST DISCOVERED. <br />V10b <br />I. FACII 1TXiNFORMAT;DN <br />FAC4IIY IDw (AgeAry UaF Only) <br />r <br />_ _ <br />HUS StN (S e9 F D.ftY AME or DHA <br />O <br />BUS `SSS IM CITY <br />Ia <br />TANK'DESCRIP170I�1 , <br />TAMP. �iY TANK MANUF 4" TAHKCONPI(RUATION. TTDSTANRIS <br />434 <br />❑LASTAND-ALDNETANK <br />�S.ONEMACOMPARTMENTEI INR, <br />D UST 5 M.INSTALLED *37 T CAppCI Y INGALLONS 435 NUMBEROFCOMPARTMENTS M 7ilE UNIT <br />43 <br />o Z <br />5D fiANKIISF::cNDG01"E2TB <br />TANK USE Ie.MOTOR VEHICLE PUSLRVG II.MARWAFVELINO 0 ia.AViATR1NFUELING <br />n9 <br />❑ 7. CHEMICAL PRODUCT STORAGE ❑ 4. HAZAADOVS WASTE OWW. UWan 0 S.EMKRGE4CYGENERATORnMLINFCIM&I.J(4)) <br />13 6.OTHER GENERATOR FUEL 095. UNRNOwN 99.OTFDaI l - <br />139, <br />CONTENTS PKCROLSVM: Ia.REOU)"ARUNLEADEb Ir. MIDGRADEUNLEADED d Ib PREMIUM <br />44P <br />3. DIESEL 133. JET FUEL CI 6. AVIATION GAS <br />0 9 -PETROLEUM BLEND FUEL d 9.OTH RPETROLEUM <br />4p <br />NONBETROLEUIII: ❑ 7. USED OIL ❑ 10. ETI 1 <br />ILOTHE NOMPETROLEUM <br />4 <br />T4. BANK, QI!iBTI IiCTIQN <br />TYPE OP TANK I. SMOLF WAIL 2. DOUBLE WALL 97. UNKNOWN <br />aJ <br />PRIASARY CONTAINMENT I. STEN, 3. FD)gRGLpS$ .2gTIEBNAL BLADDER <br />7. STEEL +INTMNALLDIING 0 97. UNKNOWN 99. OTHER 9 Q <br />a44 <br />SECONDARY CONTAINMENT 193 I. STEEL d3. FIBERGLASS ❑6.ExiERIOR ME L rui 7. JACKETED <br />4+5 <br />90. ONfi 95. U`BCNOwN 99.OTNE0. <br />VFiemrPREVENTION I.A IBLERVISUALALARM3 3. FLOAT U 3, FTJL TURK .pFF VALVE <br />u54 <br />452 <br />4-TANKMFETERr&UI FOR BCEMP170N FEOMOVERFB.LPREVENTION BDUTpMENT <br />V PIF6D.' I: AAMC L$AVG CONSTRIICTI%)lY <br />.. UCTION , .I. <br />PIPING -WAt.[.FD 99 OTHER <br />S3NGf.0WALLED�01A <br />499 <br />SYSTEMTYPE J. PRESS 3NnENIIONAL3 SAFE ..3 CCR 4 <br />CONTARNMBNt <br />/7FPRRdARY <br />1 -STEEL SS P. FL87®LE 10. R1GNPLASTI <br />EL STI <br />C] 90.NONE N d 99.OTH vNi � <br />16M <br />SECONDARY CONT UNMENT 13 A 4. FIBERGLASS 0 S.fMWLE 10.RIGIDPLASTw <br />47M <br />d 90. NONE EF 97. UNKNOWN 99.OTHER(S ' ); <br />4617 <br />PIPWG/ITIREII9E CONTAR4MENT 3 TYPE I. SINGLE WALL 9 x. DOUBLE WALL 090. <br />. '.VL i ENTrAPOIi RECO <br />• �'R) AND RISER / FILA; PII'E PiPIN� CQN&TRUGITON <br />VENTERRdARY CO AWMENT I.SYSE1. 4.naEROLA.iS IO.RUGm PLASTIC 90.NONE U99.UI <br />4414 <br />VENT SKCONDARVCONI'ADIASENT 1. EL 4, FIBERGLASS 10.RIGIDPLASTIC 90.NONE 99.OTHEt(Spw*) <br />4pr <br />V0. YCONTAINMENT 1.3 fil. 4. FIBERGLASS Ia RJOIDPLABTIC 90. NONE 99, OTHER(SpedO•) <br />+444 <br />YR SECONDARY L'ONTAmTIENT I. STEEL 4. FOJER t9. R1GAD PLASTIC 90. NONE 99. OTHER (SPI <br />db/h <br />M11 O TRAN5t710N SUMP I.SWOLE WALL x. DOUR WALL 90. NONE <br />464hi <br />al+;. <br />RZERPRIMAKYCONTAINMENr ylk I. STEEL U 4-rHIII f.AS4 U 10.RUOm PIASTI W. NONE r3 99, OTHER(Spaim <br />N <br />RIM SECONDARYCONTAINMENT I, STEEL 4.FIBER0LA33 U 10-RIGUIPLASTIC 90. NONE 9.OTNBR PI 9 <br />all <br />Mn <br />Flu COMPONENTSINST 0 'i. SPILL BUCKET 7. STR(KERNATE/SOTOMPROTECwit. 4. CONTAINMENT SUMP <br />5Qt <br />Zlw <br />VIi VND DISP£NSERCONTAINI�NT <br />CONSTRUCTION TYPE 0 L DOUBLE WALL LI 3NO DUPEMERS ❑90. NONE <br />IM4 <br />CONSTRUCTION MA 1. 6L 4. FIBERGLASS lo-RIGIDPLASTIC 0 99.OTHER ( ) <br />46b <br />_ YID.. CORROSIOI!I;PRO';('ECTION <br />STEEL COMPONENT PROTECTION C33.SACkiICIALANODE(S) 04.04PRG93®CURRENT GISOIAMN <br />IM. <br />DC, APPLICANT SIGNA4I'M <br />CERTIFICA ON: 19e1eHy that qde UST eYPlelO 6 4VaTpagbI91TIIR du heardm 4nhalaeee 4Wr9d and qui Me laity tdon pmvid9d herein E hae, <br />a99nnty <br />and IR d Elrom m <br />APPLICANT SIGN DAA I <br />470, <br />m <br />UPCF UST -B- 112 Rer. (12/2007) <br />4R <br />V <br />