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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK i OPERATING PERMIT APPLICATION-TANK INFORMATION I Re r9HH Pei�Tsi') TYPE OF ACTION (Check one item aniv. Far a(LST closure or remmal,complete only this.section and Sections t.11 Itt.IV..717 helnwl 439 ❑ I.NEW PERMIT f9 3.RENEWAL.PERMIT El 5.CHANGE OI'INFORMATION u,TEMPORARYUS!CLOSURE 7.US'T PiiRYiANiilrT CUi:S[)ALi iiN SiT'F Ej S. [1ST REMOVAL. DATE USTPERMANFNT LY CLOSED: i5na IJA'fP.GXI S'I'NG I I$T OISC(1VFRCD; +nm I. FACILITY INFORMATION FACILITY IDN(Agencv Use Ontv) A _ BUSINESS NA MF/Some as Facility Name ar DBA Dnmg Business As/ 1Z1v l's�F rr D t34 M A-0-4Nf r a6Yah BUSINESS SITE ADDRESS 93. CITY +l SD "cK Cev6r w a roc�is-rS II. TANK DESCRIPTION TANK ID N 432. TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK-ism TAD 026&1a `SOOQ Ca 1,A STAND-ALONE TANK Cnmplaneorc Pape rw uxp ❑ 2.ONLINA COMPARIMENT'EDUNrr commnmm�mp:e�n DATE L/ST YSl'EM R OF COMPARTMENTS INSTALLED 455 TANK CAPACITY IN GALLONS 43(• Nl1MBEIN THfa1N11' +51 3 ae9 s III. TANK USE AND CONTENTS TANK USE ❑ la.M(7rm VEHICLE FUELING IS WMA F'llliLlNG 111..AVIATION FUELING 439 0-CHEMICAL PRODUCT STORAGE ❑ 4.HA%ARDOUSWAS'11!(Inclw U. 00 05.EMERGENCY GENERA FOR FUEL IHSC4252a13,1 ❑ 6 OTTTER GENFRATOR FUEL ❑ 95.UNKNOWN ❑ %.OTHER(SPxiy) 439c CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED aul P,3.DIESEL ❑ 5 JET FUEL. ❑ 6.AVIATION GAS ❑ R.PETROLEUMBLENDFUE1. ❑ 9.OTHER PFIROLEUM(Specify) 4.ah NON-PETROLEUM:❑ Z USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PF.TROI.F.IJM S it)' YNk. IV. TANK CONSTRUCTION TYPE.OF"TANK ❑ I.SINGLE WALL R 2.DOUBLE WALL ❑ 95.UNKNOWN 943 PRIMARY CONTAINMENT 2,I.STEEL. ❑ 3,FIBERGLASS ❑ 6.INTERNAL.BLADDER 44+ ❑ 7.STEEL.INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(spsciy) +a4a SECONDARY CONTAINMENT CR I.S"FEEL R3.FIBERGLASS ❑ 6.EXTERIOR MF.MBRANF LINER ❑ 7.JACKFrED 445 [190.NONE 095.UNKNOWN ❑99.OFFER(Spmiy): 445a OVERFILL PREVENTION ❑ L AUDIBLE@ VISUAL ALARMS Q 2.BALLFLOAT $ 3.FILL TUBESHUT-OFF VALVE. 452 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVER rRE'VENTION F: 111PMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I.SINGLE WALL pfl2.DOUBLE WALL 09.OI'I IF:R 4MI SYSTEM TYPE J& 1.PRESSURE ❑ 2.GRAVITY ❑ ;.('UNVLNTIONALSUC'FION 134.SAFE SUCTION 125 CCR¢2(U(XeX3)1 4514 PRIMARY CONTAINMENT pg I.STEEL C,4.FIBERGLASS ❑ 81LLXI BL[[ ❑ FLR1G1DPLASHC uµ ❑ 90.NONI ❑ 95.UNKNOWN ❑ 99 Of HER(sp iy): .Iraa SECONDARY CONTAINMENT' ❑ 1 si-ELL, a4.FIBERGLASS ❑ 8,FLEXIBLE ❑ 10.RIGID-PLASTIC' 46(b. 19 WI.NONE [1 95.UNKNOWN C] 99,OTHER(Sp.Iy): 4Mc. PIPING/FURBINF.CONTAIN MENT SUMP TYPE 199 LSINGLYWALL. 0.DOUBLE WALT. % NONE uw VI. VENT, VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT LSI EEL ❑ 4.FIBERGLASS ❑ 10,RIGIDPLASnc %,NONE ❑ 99.01'HE'R(Spxiy): VENT SECONDARY CONTAINMENT VL Ls7E.E1. ❑ 4r'1BERa.nSS ❑ 10.RIGID 1>Lns'ITc ❑ %,NONE ❑ 99.(TTBER(spmiy): 4"'r un VR PRIMARY CONTAINMENT IN1.SSTEEL ❑ 4.FIBERGLASS ❑ IU.RIGID PLASTIC' ❑ >m.NONE ❑ 99.OTHER(Spe(tiy). 4I"p u pl VR SECONDARY CONfA1NMEN'I1.S'IEEI. ❑ 4.FIBERGLASS ❑ I0.RIGID PLAS'T'IC ❑ 90.NONE ❑ 99.OTHER(Specify) 4(i41i Nµbl VENT PIPING TRANSITION Sl1MP TVPI'. ❑ 1.SINGLE WALT. ❑ 2 DO(IBLF.WALL. ® IM NONE 4(''. RISER PRIMARY CONTAINMENT 191 STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ W,NONE ❑ 99.OTHER(SP.FYL j1ijl RISER SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID ' _. PI AS(-(-'- W N-ON--E- ❑ 90fHER ISPcsi yl , SPIIHU(kF1FILLCOMPONI.NISINSTAI.IiD _ T STRIKER PAI'1IH)TFOM PRO'f41( R '. 4iIL ❑ 9 !'ON"I'AIhMFNF SI'MP 'I">• ' VII. UNDER DISPENSFR CON"PAINMENT(UDC) _ "iiNSli;li('l 1:vN'TY'FF ',1 YIN(;LI'wv! r7, ] !NI!:nfiWNLI I-1 Nr:IJ!SI NS!!In T'I i �tl � ' (ON',I RI r('1 RIN MA'I'FRIAI \I VFI ❑ YI'I{iERli! \tiY ❑ In.KI.8Uu11�'Ilf _._ x T] a� r.I.IFR ISpcwlvi 17777 CiIDDf\l[f\N Rp/1T7:!`T 7l7\T ----- If, .,e. _ :au, .. .- .... -..a:un m_eu:al.- .i xuu tun uiou•mum le.a.eurd c :.0-. w urn. • n• nu i-(pl:nl, , _