Laserfiche WebLink
U .IF I EDPROGRAM CONSOLIDATED FOR M_ <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (Mv pages per lank) <br /> Paye _ of <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 1. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) 0 5. TEMPORARY SITE CLOSURE <br /> (Chock ons Aem oeA? <br /> 03.RENEWAL PERMIT 0 T. PERMANENTLY CLOSED ON SITE <br /> (SpsoA.naam-mr Mcaluu wYy) ($px+/ycMrps.Mkral use oNy) ❑ e, TANK REMOVED 4b <br /> BUSINESS NAME(Same as FAOUTY NAME or DSA-Dake BIaseasss M) FACILITY IDB <br /> LOCATION WITHIN SITE plkW 'CH <br /> TANK IDB 14 4 <br /> I.TANK DESCRIPTION <br /> n TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yea No llU <br /> W3I0180'Q AT / 1 +1 II'Yes%mmplels ww page Iw earJl com an(. _y11 <br /> DATEINSTALT IYFARA" O( TANKCACATOM <br /> PACITYINGALLOMS NUM8ENIJe PARTMENT$ <br /> �- k:1 oOp N <br /> ADDITIONAL DESCRIPTION(Ferksal we.Ny) \O"r <br /> IL TANK CONTENTS <br /> A/ TANK USE 0.)2 PETROLEUM TYPE <br /> W 1. MOTOR VEHICLE FUEL ❑Is. REGULAR UNLEADED ❑ 2. LEADED ❑ S. JET FUEL <br /> (ll MaB,comphM Mtmbum Typ) .DIE. PREMIUMUNLEADED 0 3. DIESEL 06. AVIATIONFUEL <br /> ❑ 3. NON-FUCHDJICEL PETROIXRODU T �. MIDGRADE UNLEADED ❑ 4. GASOHOL [IN. OTHER <br /> ❑ 3.CHEMIO0l PRODUCT <br /> ❑ 4. HAZARDOUS WASTE(In4cdsa COMMON NAME(rarn Hazallous MafsaMs Inranlorypage) WS/Pmm Hezaltlow McNeah Invsn(ory page) <br /> Us"00) <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ,0 1 SINGLE WALL 0 3, SINGLE WALL WITH 0 5, SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (CMckoneee,.,Wl pQ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> I - ❑ 4. SINGLE WALL IN A VAULT D gB OTHER <br /> TANK MATERIAL-primuy lW 1 BARE STEEL 0 3. FISERGLASSIPUSTIC 0 5, CONCRETE 095. UNKNOWN <br /> (Chackom Hem Bray) ❑ 2. STAINLESSSTEEL ❑4. STEEL CIAD W/FIBERGLASS 08, FRP COMPATIBLE WR 00%METHANOL ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-$wXndKy laV, 0 1 BARE STEEL aK❑z,3. FIBERGLASSIPLASTIC 0 6. FRP COMPATIBLE W1100%METHANOL 085. UNKNOWN <br /> (Check.Item pW 0 2. STAINLESS STEEL •10I 4. STEEL CUD WTIBERGIASS 0 B. FRP NON-CORRODIBLE JACKET ❑99. OTHER <br /> REINFORCED PLASTIC(FRPI 010, COATED STEEL <br /> 0 5. CONCRETE <br /> TANK INTERIOR LINING 0 1. RUBBER UNED 0 3. EPDXY LINING 06. GLASS LINING 85. UNKNOWN433 DATE INSTALLED <br /> OR COATING <br /> 0 2. ALKYD LINING 0 4, PHENOLIC LINING 06. UNLINED D W. OTHER <br /> (LEeck oru item on (Fwleul use <br /> OTHER CORROSION 0 1 MANUFACTURED CATHODIC 0 3. FIBERGLASS REINFORCED PLASTIC 085. UNKNOWN 434 DATEINSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ I. IMPRESSED CURRENT 098. OTHER <br /> (Check one ibm oMYl ❑ 3. SACRIFICIALANODE (Fprbcal use oMy) <br /> SPILLANDOVERFILL YEAR INSTALLED TYPE(F.Wal uw-my) OVERFILL PROTECTION EQUIPMENT'.YEAR INSTALLED <br /> (Checkam.lapply) � 1 SPILLCONTAINMENT A Cl 1.ALARM 3, FILL TUBE SHUT OFF VALVE_ <br /> 2. DROPTUSE 11 I�•2. BALL FLOAT 0 A. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> 'N.TANK LEAK DETECTION <br /> IF SINGLE WALL TANK Check eB theta IF DOUBLE WALL TANK OR TANK WITH BUDDER CA kone lmm an )' <br /> 0 1. VISUAL(EXPOSED PORTION ONLY) 0 S. MANUAL TANK GAUGING INTO) 0 1, VISUAL(SINGLE WALL IN VAULT ONLY) <br /> 0 2. AUTOMATIC TANK GAUGING(ATG) 0 6. VADOSEZONE 0 2. CONTINUOUS INTERSTITIAL MONITORING <br /> 0 3. CONTINUOUSATG 0 T. GROUNDWATER 0 3. MANUALMONITORING <br /> 0 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• 0 B. TANK TESTING . <br /> BIENNIAL TANK TESTING [I 9L OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PUCE <br /> ESTIMATED DATE UST USED(YRIMOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED VATH INERT MATERIAL? <br /> gtllone 0 Vas ON. <br /> CUPAFORM(4199) Formerly SVJRCB Form B <br />