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CO �. <br /> UNIFIED,PRDGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS- TANK PAGE 1 // [ <br /> GwO Pages perfank) <br /> TYPE.OP ACTION ❑ I-NEW PERMITaPage-Of_ <br /> ([te <br /> ❑ 4.AM&LADED PERMIT � 5.CHANIGE OF INFORMATION <br /> choreitaconb) 133,RENEWAL FERMI"I' ® 6.7EMPOIiARY TANK CLOSURTs 430. <br /> ptt � � ❑ 7.�RMANENTLY CLOjM ON SITE <br /> 13 SINESS.NAME(5wuc as Fh G CSPKi4 reason) 11 7. <br /> mason) <br /> ar rRA-aolog Business Ac) 3 PACILI ❑ G.TANK RE.&IOVBD <br /> fq(110d WITH N SITE(opounsl) <br /> �� _ . iq <br /> 421 <br /> TANK ID p aaz TANK MANUFACTURER ~N 43+. <br /> o TlIac a P'-,( CDM PARTIVIEN'A1,17ED TANK <br /> ATE. NTALLED 435. <br /> Ye8 Q.1Io 454. <br /> TANKCAPACTTYINGALLI]I�IS 4 <br /> 36, 1e°Ya' caaplaeeowrnactbrcachwmpa'coriS <br /> L a <br /> i <br /> (YEAR/MU) 9 ry NUMBER OF COMPARTMENTl !- 0� - 437. <br /> ADDITIONAL DF RIPTTON(Fnr Iucal Asa amiY) IA <br /> 433. <br /> TANK I13F. 439, J " <br /> PETROLEUM <br /> 1. MOTOR <br /> VMUCLE FUEL C]La. REGULAR UNLEADED <br /> (IFehttked,mmAlere Petroleos Tree) ❑2. LE"ED ❑5.JET FUEL 41Q., <br /> Cl 2. NON-FUEL PETROLEUM ❑Hr. PREMIUM LNLEADFJ) OJ. DMSEL <br /> C1 lc. MI1XlRAf)EUNLEADED [16. AVIATION CAS <br /> ❑ 3. CHP.MICAL PRODUCT' 0 4. GASOHOL ❑99,OTIIBR: <br /> COMMON NAME(IlomM <br /> HacardcueatciaktmMlwypaaa) 44t• UAS# <br /> ❑ 4. HD4US W A3T6 {$vm Eazerao g Maurfxl�rn weneny tune) <br /> O>lsludn Used ed pi� 442 <br /> Ll uNKxowN r{�;} <br /> TYPEflFTANK 1. SINGLE WALL <br /> (Check one item only) 3. SINOLE WALL WWII E?7[IERIOR ❑5. SINGLH WALL WITH � D <br /> MEMBRANE LINER ❑95. UNKNOWNAL BLADDER SYSTEM 443 <br /> TANK MATERIAL-al 1. DOUBLE WALL ❑4. SIMLE WALL INA VAULT <br /> �.I. BARE STEEL ❑3. PMERULASS(PLASTIC 99 OTHER <br /> ('Check wie aero") ❑2, STAINLESS S`EE{L S. CONCRETE �]95.UNKNOWN <br /> ❑4. STEEL CLAM WAFIBHRCLASS ❑B, FRP COMPATIBLE 4♦4. <br /> TANK MATERIAL- REINFORCED PLASTIC F W/IOW METHANOL 44.OTHER: <br /> secon.dar3'4uk ❑1. BARE STEEL 3. PIBERC9l.ASS I ALASTTC <br /> (CLetk all[taco cry) ❑2 STAINLESS SI'PSL 4. STEEL CLAD W✓FI$ERGLASS ❑B. ARP COls1f:ITOLE W/E W%METHANOL 95.[JI IKNOWh4 4e5 <br /> RHINFORCHD PLASTIC FRP ❑9' FRP NORI C6RRODABLC JACKBT 1199.0THER <br /> 5. CONCRETE ( ) ❑10. COA•1ED STEEL <br /> TANK INTERIOR LII+IING I.I2UI;BEJLLINED <br /> OR COATING ❑2.ALKYEf LINING Ll 4 EPDXY LI, Gy ❑5,GLASS LINING71 1 95.UNKNOWN <br /> (Check aoe item ant ) ❑ PHENOLIC LININO ®6.UNLINIiD ❑99„OTHER <br /> 446, DATE INSTALLED 447, <br /> OTIIERCORROSION l.MANINPACI)WE THUDIC 3.FBFRGLASgREIPIFpRCHDYLASCTC <br /> PROTpCT1ON PROI7:CTION ❑95.UNKNOWN <br /> if Iicable 2.SACRIFICL0.L ANODE 4.IMPRESSED CURRENT ❑99.OTHER 448. DATE INSTALLED 449. <br /> SPILL MTD OVERFILL YIAR INSTALLED ass. TYPE <br /> (Cbec]c all thtc rPPly) ❑❑3.DROP TUBE M _-4 431. OVERFILL PRIUMICT70NN EQ�UIPMEN1': YEAR RJSTALI5D <br /> ❑1.ALARM ❑3.FILL TUBE SHUT OFA VALVE 411 <br /> 3.STRIKER PLAT$ Q 2.BALL FLOAT ❑4.8)MNIPT --- <br /> !F SINGLE WALL TANK W - <br /> (Check all that apply) 453. - <br /> IP DOUBLE WALL TANK OR TAMC WITH BLADDER 45A <br /> ❑ <br /> I. VISUAL(B){P()SFD PORTION ONLY) (Check ooe;tern only) <br /> ©2.AUTOMATIC TANK GAUGING[ATG) ❑S.MANUAL TANK GAUGING(MTG) C1I.VISUAL(SINGLE WALL IN VAULT ONLY) <br /> El 3. CONTINUOUS ATG 115•VADOSB ZONE Kt-CONTINUOUS wTHRSTITiAL MONITORINCr <br /> C3 7.GROUNDWATER <br /> ❑4.STATISTICAL INVLrNTORY RECONCILIATION ❑3.MANUAL MOMTORIN`; <br /> ❑B.TANK TESTING <br /> (SIR)+BIENINIALTANKTESTING ❑99. 0THER <br /> 25TI;14ATED[)ATII LAST USED(YR/MO/DAY'W.:. _ <br /> 1 4 55 ESTP-4ATED QUANTITY OP SiJBSTANCE REMAWING "per # <br /> 456 TANK FILLVD WITH INERT MATEIU,,l 457. <br /> �llous <br /> ❑Yes ❑ No <br /> '!FCF hwfwre-b(L/99)-I/4 <br /> hll p:Jlwww.unldocs.nrR <br /> Rev.02AIWI) <br /> •d <br /> Xd3 13f'd3SU-1 dH Wda T :C 900a To jJU <br />