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r cu), <br /> UNIFIED PROG,R SAI CONSOLIDATED FORM <br /> UNDERGROUNDSTORAGE <br /> CE TANKS •- TANK PAGE 1 <br /> (Two pages Per Lank) <br /> TYPE QF ACTION ❑ L[+NEW PERMIT -. <br /> a 4.AMENDR5 PERMIT S.CILANGL Df Pagc-of <br /> (LhRh an:ilcm uniYY (] 3.RENEWAL PERMIT FORMATION ❑ 6.TEMPORARY TANK CLOSURE <br /> tA.� C-EL 410. <br /> (S]Pwhy,seen) ❑ 7.Pl R"4ANENTLY CLOSED ON SITE <br /> BUS S NAME (Specifyueawn) ❑ R 7AIFKREMOYED <br /> 1� INE (8ameesFA JLiIYNAM� rll13A-Dai�Bazneas tsj 3 FACdLTf <br /> - 10F L(]CATI(IN WITHIh1 SITF(r]PmsIr <br /> 43 I. <br /> tit rias . <br /> 'CANk ILT# l�i��sd"Ilr - i <br /> � ��' (� Ti�K MA.NUrACT-URCR B:-UI 413 llnra`Tks Shall 4?e ro rh 3rxal <br /> � }1� {Q i rrj ��S 473 COMPAK_.N*NTAI.J7.F.I7 TAh <br /> 3C Yes [] No 434 w <br /> kw_ATEINSTALLED 435 If CAPACITYINGALLONS I["Y` "wmplercasepueageathcompwi,rent <br /> (YEAWMCI) 4336. NUMBER OF COMPARTMENTS <br /> I <br /> L1%.. a 0 467 <br /> ADDITIONAL DESCRIPTION(Fcr(oral um onL�) <br /> 438. <br /> TANK <br /> NK USE 435. _.rn <br /> PFrROLBUM T7 PE <br /> �r ILL. <br /> 1. MOTDR VEHICLE FUEL - <br /> (If checked.e6nplere Pennleom Type) Q la' REGULAR MLEADED ❑z LEAD7DEL 449 <br /> Ib. PREMIUM UNLFADF.D ❑S- JET FT IO <br /> 11 2. NON-FUEL PETROLEUM ❑3. DIESEL ❑6. AVIATIONGAS <br /> . MIDORA W UNLEADED ❑4 GASOHOL <br /> ❑ 3. CHSMJCALPRDDUCT 11 la <br /> COMM(]N NAME(ft-j,_d._^Aatertalslnvertro. 1:199.OTHER: <br /> ❑ 4. HAZARDOUS WASTE ry pap) 441, CA S9 Hamrdnyc Mrtkrialslmrenlvey yaac) q-tq <br /> (Includes Uv d Oil) ■+ ,6y <br /> ❑ 95 UNKNOWN <br /> U - 1 <br /> 4 <br /> TYFEOFTANK 1 SINGLE WALL C' <br /> (Check ole item only) 3, 5141 LL 15ALL WI I H EXTElt1OR ,- <br /> hiENIBRANE L WER CI S. S],"'OL E WALL WITH INTERNAL HLA7ILIER SYSTEM 443, <br /> TANK h(ATERIA! - 2, DOUBLE WAIL 4. SINGLE L'E L IN A VAULT ❑95- UNKNOWN <br /> P^"�s5'link . BARE STEEL ❑3, FI13$RGLASS i PLASTIC 99- OTHER <br /> (Check axle hem aaly) ❑2-57A1NLESS STEEL �4. STEEL CLAD WIFIBERGLASS i' CONCRETE []95.UNKNOWN <br /> ____ ❑9. FRP COMPAI ISLE �4' <br /> TANK MATERIAL-seronda rank L BARE STEEL R£LtvFORCED PLASTfC ❑ OTHER: <br /> � 1.. t�18ERGLASS/PI.gSTII' W/IQ0561NETI(ANDL '--'-� <br /> (Check One item only) []2. STAINLESS STEEL L-11 FRP COMPTIBLE W/Iap';JV ETHANOL 95.UNICNUWN 443 <br /> ❑4- STEEL CLAD W/FIBERGLASS 1:39, FRP NUN-CORRODABLE JACKET _ <br /> REINFORCED PLASTIC(FRF) ❑1G, COATED STSF.L. ❑44 OCHER <br /> TAMC INTERIOR LCNING S- CONCRETE <br /> 1.RUBDER LINED 3.EPQXY LININC: ❑S.Gi.A.45 I.LNING <br /> OR CUA TING ❑2.ALKYD LINh.NG ❑95 OWN 446 DATE INSTALLED 467 <br /> Check one ilem onl ) d 4.PHENULJC LINING []6,UNLINED ❑99,OTHER <br /> OTHER CORRDSION L MANUFACTURED CATHQDiC " <br /> PROTECTION PROTECTIQN �3•FIBFRGLASSREINFORCEDPLAOTHERER <br /> STIC 095.UNMOWN <br /> If A licable Z.SACIFJFICEANODE ❑4.IMPRESSED CURRENT 419. DATE WSTALLED 449 <br /> AL ❑94. <br /> SPILL AND OVERFILL YEAR INSTALLED 650 TYPE <br /> (Check all thal apply) ❑ I.SPILL CONTAINMENT 45L OVERFILL PRO'IECI'ION EQlI1PMEIYT: YEAR INSTALLED 432, <br /> ❑2 DROP TUBI ❑I-ALAR-n�l ` Q 3.FILL TUBE SHUT OFF VALVE <br /> ❑3 STRIKER PLATE ❑2.BALL FLOAT []4.EXEMPT - - <br /> , ovi <br /> r �T <br /> (F;.1cys:rJlYJ�i t3f 'Ili 51Ja1t'Ftesubmittecl is the 1c5I a�ap�4y) <br /> IF stIVGLE WALL ra�(Ic - <br /> (14,kTl dial appy) 4SI IF DOUBLE WALL TANK OR TANK Wl'1([13L!lL)UI R <br /> 454 <br /> []1. VISUAL(EXPOSED PORTION ONL'!) ❑S.MANUAL TANK GAUGING'MIG (L heck one item only) <br /> C7 2.AUTOMATIC TANK GAUGING(ATG) l ! ❑I-VISUAL(9rh3GLE WALL IN VAULT ONLY) <br /> L1 6,YADOSE 20N1 <br /> 3.CONTINUOUS ATG �.CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ [;7-GROUNDWATER <br /> ❑4-STA'IISTJCAL INVENTORY RECDNL'L.IA'IION [3 3-MANUAL h1UNITDRJNG <br /> ❑8.TANK TESTING <br /> (SIR)+BIENNIAL TANK TESTING [ 4r3.OTHER <br /> - - <br /> ti T;t-11t CL()6URL INF0WV1,1'I10N/ FERINI_}11EN I <br /> E311\IAITT)DATE LAST USED <br /> i O j 455 LSTI1vIATFD QUA'v(f'..Y OI�SUBSTANCF KELIAINING 456 ...0 <br /> �lI TANK FILLED WITH LNERT^.EAIERIAL'1 13"'. <br /> - gallons <br /> - - - - - -- - ❑Yea L' R'o <br /> UPCF hwfwrc-b(1199)-1/4 hitp://www.unidemorl <br /> Rev.02/16/00 <br /> ' d <br /> X»d 13rd-11s 1-1 JH WdGT =E 9006 Ta -idH <br />