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VAN DE POL Fax:2094661910 Dec 23 2009 11:15 P.07 <br />UNIFIED PROGRAM CONSOLWAT$D FORM <br />UNDERGROUND3TORAGETANK <br />OPERATING PERMIT APPLICATION- TANK INFORMATION Oqa famt <br />us <br />TYPE OP ACTION (Cl edt oqa It:n amy. P UST Pwtmnmt closttte & r q 21, complete only th(6 Seetloq and Sectioga (, II, DT, IV. end DC below) <br />E3 I. NEW PERMIT Cal <br />4 311 <br />3, RENEWAL PERMIT ❑ S. GRANDE INFORMATION <br />6, TT@4IPORARY UST CLOSURE 7. UST PERMANENT' CLOSUR$ ON SITE <br />S. UST REMOVAL <br />DATE VST PERMANENTLY CLOUD: <br />DATE EXISTING UST DISCOVERED: <br />sloe <br />; . L'FACILII fi .INFORMATION, <br />FAC IDR (Agrrrry Ure �'J <br />BU 53 (( 0 9a PAC or <br />BU3 SC c� , lol <br />� <br />Q1 r <br />too <br />l <br />IL' FANICDF$CR>PTIO <br />'LANK ID# 43a TANK MANUFACfU TANKCOMMIATION: TIRSTANRIS <br />J;1. A STANINALONE TANK <br />20N5 INA CObOARTMFN-MO UNIT. <br />DAT@ UST SYSTEM INSTALLED 433 T IN GALLONS 6 W e <br />ER�� MPARTMENTS IN THE <br />0 <br />USZL� 77 <br />TANK USE la. MOTOR VfdECI.E PURLING le. MARINA RMLDiO la AVIATION FUELING <br />4. CHEMICAL PRODUCT STORAGE ❑ 4.NAEARDOU3WAST8(bdg1rU d0R) ❑ 3- MMMGIINCY GENERATOR FUEL (W <br />6.0TN$R <br />GENERATOR FUEL 1]93, UNKNOWN pq, 0TM( <br />CONTENTS <br />as1 <br />PERIOLBUM: la. REGULAR UN,$gp@D ❑4 l4 MIDGRApE UNLEADED 16. PSEMUM UNLEADED <br />40 <br />3.0®BEL u 3.3BTYM 0 6. AVIATION OAS <br />S. PETROLEUM SLBND FUEL 9.OTRI4R PETROLEUM <br />440mNON <br />PETROLEDM T. USED 611. 10. ETHANOL <br />8 <br />11. TNBRN N•PSTBOLEUM ' ; <br />:. CTLON. <br />4(p1 <br />E <br />TYPE OF 1. SIN LE WALL E. DOV"Ne wALt 9s. DNKNOwn <br />PRIMARY COMA ENT I.ST@@L <br />�« <br />J. FIBERGLASS 6. INTERNAL BLADD JOR <br />7.sTEEL+MnRNI L(.DJING 95.UNKNOWN 99. 113 2 <br />. <br />SECONDARY COWFA NP I, STEEL. 0 3. FIBERGLASS <br />yy <br />fi. IiXT@R[OR MEM BANE L . 5A 7ED <br />Q. 90. NON$. 95.UNKNOW)J 49, <br />4 413 <br />OVERFILL N 1. A LES: SUAL ALARMS A FALL FTAAT 3. FILL TVW SHUTW VALVE <br />444 <br />4, T'ANLMMTS Re 8MB FOR EXEMPTON FROM OVm(F .L PREVENTION EQUIPMENT <br />V-11ROO.tlCT % <br />WINO CONSTRUCTION 1 SINGLE WALLED a. DOUBLE WALLED LJ 99. <br />SYSTEM TYPE I. PRESSURE .GRAVRY S. CONVEN710NAL SUCTi N 6.SAP890CT(ON 31 <br />FRIM.ARYCONTAINMENT (. STEEL <br />4. FIBERGLASS S. FLEXIBLE ri lR RIOtD PLASTO <br />90. NONE 095. UNKNOWN ❑ 99.OTNER(S <br />CONTAINMENT ❑ (. STEL 4. FfBMWLASS S. FL&YIeLeI0, RUSID PLAST[C <br />464486CONE)ARY <br />go. NONE 0 95. UNKNOWNPTPI-NG99.OTITER ): <br />CO NTAINMEM SUMP TYPE I.SIN WALL 1. <br />My <br />. DO W 90. NONE <br />�C,O / FILE P1P11V�G ' H$TRiTG'PI01�6 <br />4644 <br />EYT. <br />VENT..:• Y CONTAINMENT1. TEEL 4. FB GLASS 10. RI m P 9R NOW 99. (Speaigq <br />46b <br />VWTS NDA Y CONTAINMENT L STEEL 4, FIBERGLASSQ IL RtGID PLASTIC 0 011 --KONG Li 99.OTN (3p4e1Q9444f <br />VRP AAYCONTAINMENT 1. TEEL LJ 4.F LASS Jo RWID PLASTIC 90, N--ORF-07W---- <br />( P4Nb) <br />461 <br />V4 <br />ECONDARY CONTAMNNfBNT I. STEEL 4. ®ERIKA$$ 0. ON PLASTIC 90.NONE 99.OTN R(Spmi�) <br />464.1 <br />4611 <br />VEMPIPIn TRANSITION SUMP TNP9 {. S@V eWALL P LE ALL O <br />4 <br />RISER PP AKY CO AINMENT 1. STEEL 4. FISEROLASS 10. RIGIDP TIC Ll 90. NONE u 99.m (Spcdo) <br />4/Ai <br />RISERsE ONDARY CONTAINMENT I. S 4,FOUROM E3 10. RIGIDPLASTICC390. NON @ 99.OTHER (Spally <br />x <br />PtU. COMON8N1'S INSTALLED 1. SPILL BUCKET J, STK9=P TE(EOTTOM PROTECT R 4, CONTADquBNT SUMP <br />a" <br />VIS. 1SRDISPENgER'CONTAIDTMf61vT; <br />caIBTR Swat. @ WALL ❑ a, OOUBLB WALL 3, NO DISPENSERS 90. NONE <br />CrioNTY 1. MEL A PfBEROLASS 10. RIGID PLAB , OfWsR <br />t, :..: ...0 m colm06TDPFRR(>7BGTION . ' <br />MMCOMPONENTPROTEMM a.SACRtFICMANODS(S) Q 4. NPRP,SSED CURRENT 0 6. ISOLATION <br />APPLICANT SIGNA <br />CEB77FiCATTON: i artify Wat this UST sy§tm is compilthle wlth the hanrdg sah:tagee stored Sed (Ant the iSfgrm;ltloR plovlded hero4 !r Use, aeaaeaty <br />Sell IS (all co @sate wRh i d r gllemegb. <br />APPLICANT SIGNATURE <br />DATE <br />APPLICANT NAME (plot) 471' <br />APPLICANT TITLE <br />471 <br />UPCF (IST -B • 1n <br />Re9.(lariooT) <br />