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VAN DE POL <br />Fax:2094661910 Feb 1 2010 9:21 P.09 <br />0 <br />UNIFIED PROGRAM CONSOLIDATED <br />FORM <br />STORAGE TANIi <br />TING PERMIT APPLICATION <br />TYPE OP ACTION (Che9it n <br />;�, may, -TANK INFORMATION 004 form <br />1. NEW PERMIT <br />6. <br />uPERMIT <br />U <br />Pe9rttlanimt obsure or rwnoYs4'"Pen. only MIA aectiaa antl Seetiona <br />3. RENEWAL PSRMR IL lD. <br />. <br />Y UST CLO <br />URE IVB and IX balm) <br />7. UST PtitMANSNI' S. NGE OF iNPORMATION <br />DATH USTP[3tMANSNTI.Y C <br />D, C SURE ON SICK USNT REMOV <br />E7gM745 UST DMCOVEREp; <br />P S.[TYID9(AgaliOR S- I.: FA6'lfl'IYIl�FFORI�.A770N':' ".... <br />SU SS ( b <br />a ) <br />us s <br />1 <br />Iw C <br />TANKmA <br />4 <br />ITA NX .... <br />'TANK <br />�I <br />..... :... . <br />A T CONwGRJaA710N: TMS TANK IS <br />�{'p�l� A STANDALONE <br />W (� <br />, TANK <br />vv 2. <br />DATE BYBTBM RUST <br />a..J ONE IN A Coa@AATAU;M UNrr. <br />IN <br />� <br />T JN OALLAMS 111 <br />1 FCO S AV TTL <br />O <br />"'; '::. .•.,i ..{'. Iry ?: ' <br />• ..qg a_•!IRii'I'AL'AiC'iT5$:>j,N9.�N'TLNTS�..'.: :. ; _. <br />TANK u <br />Ia.MOTOA <br />3. CHEMICAL <br />PO C3 Ik MARINA PURLING <br />.. <br />6.OMERO <br />STOR 10. AtRA'RON PU84IN0 <br />TOA �LRAOE Q A HAZARDOUS WASTS(aiBal�UW w)It <br />95•UNIWOWpt Q L emBR08NCY OENBRATDRFURL0gCg931gI <br />CONIEN'CS PETROLEUM: <br />1>. ABOULAA UNLEADI 99.OTNER l <br />Q la MOORADE UNLBADRD tlf <br />I0. PREMUM UM,EADBD <br />3. DIT$EL ❑ a.JETFUIL <br />NON•PETAOLRUM: <br />S. PETROLEUM BI.RND FUEL 9,OTHER PRDtOLEUM ❑ 6. AVIATION GAS <br />7. USED Q S . <br />10. BTNANO(, <br />M0 <br />,.; .; .:..:. ...IERNuW <br />. tB ft <br />TYPE <br />I i' 'TANI(;CQN,9 Eta <br />4iR <br />OFT <br />PR <br />PRIMARY CONPAINMENP <br />WALL 2. DOUBLE WALL 96. WN <br />1. STBBL <br />3. FIBEROGt38 6. INTERNAL BL.App <br />7. STEEL+IN7BANAL LINING <br />SECONDARY CONTAEJMENI <br />t. STEEL 3.P BAG1A88 9J. WV <br />6. EXTERIOR MBM sC <br />446 <br />OVERP P NT <br />L 'A <br />90.N 93.11NRW0 <br />1•A III VISUAL ,0 )' <br />4 T .HALL OA 3. SH OFF VAL - <br />M¢TS R6 S FOR EXEMPTION PROM OVRRFDI, FRRVENTION <br />444 <br />f' <br />PJPIND <br />BQOIPMal <br />tra,'PROAIIG11�4A3T:PIPIN.QONiTZU('FION <br />COI. <br />TYPE. <br />SINGER -W 2. DO LE•WALLED 99.OTNRR <br />PRIMARY COW NT <br />L.P Sau GRAVITY <br />E <br />1.87$84 4, FIBERGLASS AFI.fiXIBLfi NAL SUCTION 4 FION CCR aG I <br />. SECONDARY CO <br />P <br />III 011 S <br />10. NON, 9q•UNKNOWN ❑ 13 10.A TIC <br />4W <br />4. PIBeROLA33 S.PLEJITBLE <br />9M NONE 97. UNKNOWN 10. RIGID PLASTIC <br />Q 99.QT m <br />4aro <br />PIPB30/1TIRBW6CONTAINMSMS <br />1: <br />TYPE 1. OLE WAL 2. <br />4M <br />WALL <br />� PIII&.P <br />K orrr E <br />VEI9TSECONDABY CONTAINMENT <br />S INGG SiRUCiION.. <br />!. SL 4. ROGSS 1 RIGO 7IC 90. NONE A (Spe ly) <br />VR PR AAY NI <br />1, STEEL 4. BAGI.ASB 10. OmP STIC NONE . OTHfiR (Will <br />61f <br />VR <br />1. S SL 4. FIBtA/OI.ASS !0. R101DPLA$TIC 90. NONfi 99. TNeR ($paei4•) <br />� a <br />NDARY CO AINMBNT <br />1. STP3IL L3 4. PIBBRALASS {0. $ITJN PLASTIC 90. NONE 99, 8A ($yatQ•) <br />V@fTN MSLfMP <br />RSDRP YM <br />CO <br />.SING ALL 2 WALL <br />1. STEEL {,P®ERDLA83 10, <br />RL4 AAY CONT NMBI?I' <br />ID PLASTIC 90. NONE 99.OTNeA (SpaNp•) <br />1.5 BL <br />CSBC <br />PILL C <br />4.F®BRGLASS 10AUG PLASM 9p, NO .OTFiBR (8pedg9 <br />IVIS INBTALLBD <br />1. Sp BUCKET 3.37 PLA M TBCro {. S <br />1 <br />' <br />$ I11�JASRIBRRGLnsE ER C <br />re <br />CON9T&UCTNN.TYPB <br />U <br />❑ t INOL.B WALL Q DOURER WALL ], No DISPBN8ER3 <br />N nw'TBR4tL4. <br />1 9a NONE <br />I P4ASTTC 99.anlsR <br />CORROSIi1d'1`PROTECTTON <br />STEEL COMPpN8N1'PROTBCSIpN <br />Q LSACR67CW,ANODS(a) Q 4. IMPRESSED CURRENT Q 6. NOLATION <br />"L <br />' <br />IX Ar CANT SIGNATURE <br />..UST <br />C1dRTIPTCATCON: f Nrtl(P flet ayaaaq'if earnpaliDle Ili tk KWedeaa "Rebates sImad <br />and LA 14,E 9 <br />and that the IR(OPY4119R <br />4090 wl I il uim=Ab. P�'1d4d her In Is lime. a"ef <br />el <br />APPLICANT 8i <br />DAIS <br />r ' <br />4 <br />APPLICANT*ln5 e T l i) <br />471. <br />MPLtCMCC TITLBI <br />Ull Ul_I <br />Rev. (I VM7) <br />