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evtu It 1 a <br /> UNIFIED FROG CONSOL DATED FORM <br /> UNDERGROUND STORAGE TANK u Z <br /> OPERATING PERMIT APPLICATION- R� �" <br /> TYPE OF ACTION y TANK I ATIO (One p0ml per US 1) <br /> (Check one ilern onl. !•br n US%'clanu'e m renrorn/,complete au/y Ihit rection mrr/Secliont/,//,///lP,nnrl/,YbelanJ qo. <br /> $'.NEWORARY 03.RENEWALPIiRMI'1' <br /> 6.TEMPORARY US'f CLOSURE 7.UST PERMANEN'I'CLOSURE ON SITE 05.Cf IANGE OPINI'ORMATION <br /> DATE UST PERMANENTLY CLOSED: S.US'T REMOVAI. <br /> _ 4�m. DATE nXIS'TING US'1UISCOVERED: <br /> FACILITY L FACILITY INFOFACILITY IU N(dgency Utc UnlyJ RMATION <br /> BUSINESS NAME(S'ame as) Nnme m•URA--Poing Rruineu At) <br /> I. <br /> BUSINESS SITE ADDRESS c! C7 ![v J <br /> _ / lo. I• la. <br /> IANKIDN ' . II,: TANKDESCRIPTION c� <br /> ux. TANK MAI......I'DREIt 411 <br /> TANKASTANIG LONEION:'1'HIS'1'ANK IS n4. <br /> DA H.USI SYS'IT I STALLED +Js. 01.ASI'ANA ALONE TANK <br /> 'I'ANKCAPACITYINGAL ONS 4J6 Z.ONEINA COMPAR7ML•M'EU c°mPl"L 0ALµ'%°ra rxh <br /> J� L-•'✓�[.✓,� 5'0 NUMBEROP COMPAIt'I'MENTSI(NTUpUlvT in rhe wl14 <br /> ' -UNIT' us. <br /> Ill. TANK USE AND CONTENTS' <br /> TANK USE �..�r�•M01OR VEHICLEFUM.ING <br /> LJ s CNLMICAI.PRODUCT STORAGE Ib.MARINA FURLING ❑ le,AVIATION FULLING <br /> �4DTfIfR CIiNENAf014 FUEL 04'HAZARDOUS WASTC•(Inchrdn Used at) ❑S.f;MERGf;NCY GENERATOR fUE1.IRSC FJ6291.6(g119 <br /> ❑9S.UNKNOWN <br /> CON'TEN'T'$ PRTROI.EIIM: .-'__. .._ .-_.___.__-________�.-_-v_____._____--.__-.__ . <br /> I�•in RfGUf AR UNLEADED 0 Ic MIDGRApC UNLEADRO 99.D(HER(Specify), 1191 <br /> ❑ 7 DIESEL' 0 5 JETI•'UEL ❑ Ib PREMIUM UNLL'ADED 44- <br /> _,. 0 7 PETROLEUM BLEND I+UCL 0 6 AVIATION GAS 440. <br /> NON PrIROLLeI/M �9 DT11fR1 <br /> CTROLL•UM(Specify):_. <br /> 011 O)HOII - 010.GffIANOL <br /> ❑ iI,OI'IIEIE NON PGfR01.EUM S rrf - ------ <br /> -TYPC Of TANK <br /> IV TANK,CONSTRUCTION 4406 <br /> -ONT ---__.,_ SINGLE'WALL ❑ 2:D000I L WALL __ <br /> PRIMARY CONTAINMGN'1' ❑ 9s UNKNOWN <br /> S1TLL 0) FIBERGLASS - <br /> "- - 7SfCEL_+_INTERNAL LINING 04INTERNALDLAUDIR -'- <br /> 44J. <br /> SCCONDARY CONTAINMENT ❑ I SIELLFIBERGLASS <br /> -.._....0 95 UNKNOWN ❑ 99 OTHER(Specify), a4. <br /> ❑J PIOCRGI ASS 0 4 [EXTERIOR MfMDRANI:LINER 444° <br /> OVLRI ILL I'ItIiV6N'1'ION - -- NONC_.,- 0 9).UNKNOWN ❑ 7.JACKP.TCr <br /> ❑ I <br /> AUDIBLE-i VISUAL ALARMS -' -�-. OTHER2,BALL FLOAT .(SPmrfy) 445 <br /> 4.TANK MEf.fs ltf; I111tEML'NiS TOO CXEMPTION ROM OVCRI'I LL PRRVENTIONE UT'OFF VAI' it/Q/f <br /> 0 ] TILL AIDE Sfil1T-0rF LV <br /> h 452; <br /> V:`PRODUCT/WASTE PIPING CONSTRUCTION <br /> I'II1NG CONS'fltUCl'ION <br /> SYSTEM TNSfq-_ - - SINGLE tVAII ❑ 9 UOUIILL RALE ❑ 99 UTI11 <br /> -. -_Q 1 rRCSSURI. (RANIIY . <br /> PRIMARY CONTAINMCN'f ori, CONVENIYONAL SUCTION 460 <br /> �c.r EEL ❑ 4 IIDERGLAS$ - _._._0 4 SN CSUCTION 2J CCN...i616Op1 <br /> ❑ 90.NONE ❑ S.TLEXIDLIi ) 464... <br /> ---- ---- _ ❑ 95 UNKNOWN ❑ Io.RIG1O PLA57'IC ' <br /> SL•CONDAItY CONfA1NMENT❑ 1 ST IBE _ -_O 99 oTHI R.(Sparfy), rci: <br /> ❑ d FIBERGLASS 0 a CI OTHER <br /> n64� <br /> �.90 NONE; _ El 95: ❑ 10.RIGID PLAS77C 461L.- <br /> PIPING/7LIREINB CONIAINMF,NI SI/MP TYPE _ --"- __�.990TIILR(Specify): <br /> ❑ L.SIN(IhI,WAIL ❑ 2 DOUBLE WALL 90 NONE <br /> 4640 <br /> VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILLPIPE PIPING CONSTRUCTION '6,e <br /> VENT PRIMARYCON7CNT <br /> -- AINM �-I.STEM ❑ 4.FIBEI2GLnSS ❑ 10 RIGID PLASTIC ❑ 90 h'UNL <br /> VENT SICONDAR---- INMEN7 ❑ I.STfrl -' -' -- 0 °9 OI'NER(Spccify): 4640. <br /> _- ' _ ❑4FIDERGLASS - - n -' <br /> 0 10 RIGID PLASTIC 46141. <br /> Vi--PRIMARY CONInIVMf-NT .... r 90 DONE _. <br /> __. p, ❑ 99 oillllt(Sprciry): riif- <br /> '-- ❑ I... l ❑ / FIBERGLASS <br /> VR SECONDARY CONTAINMF.N'1 El 1° RIGID R,nsT1c �'90 Norve - 464n <br /> __. ❑ 99 OI HER(Spmry): <br /> ❑ L STERE ❑ 4.I•IDERGLA,SS U " 461. <br /> VENT PII'1NG'I'RANSITION SUMP'I'YPF: ❑ 10 RIGID PI ASIIC . 90 NONE y" r.1 <br /> . ❑ 99 Of HER(Slxcify): i64h <br /> RISER PRIMARY CONTAINMENT O I.SINGLE WALL CI2.UOIIBLb WALL k90.NON[ - 444h1. <br /> RISCR SECONDARY CONTAINMENT 0 4`I98I:RGLASS 0 1�p RIG)D PLASTIC 90 NONE <br /> 0 I STEEL ❑4 FIDHROLASS -' 0 qq07IIL•R(Spcafy); 4611. <br /> FILL COMPONENTS INS7ALIAiIj - _ ❑ 1°RIGID PLnS'nC 90 NONC ❑ 99 OIIIER(SPrnfy): 4641. <br /> ❑ 1 SPILL BUCKET ❑ 7 STRIKIRI'I A71dR0 fl'OM pR071'CI OR -VIE 601 UNDER DISPENSER CONTAINMENT(UDC) a�� <br /> ❑ d.CONI AINMGNT SUMP N i}43ta< <br /> CQNS7 RU('110N'rYPh ' <br /> CONSII2UC1'ION MA I'F;ItIALOLSwGIFwn1,L_. .__-_._.O.9 nouin.E WALL <br /> ❑ STEIih ❑ ].NO DISI'ENSIfIiS❑ 0.NONE. 46%,4.PIBCRQ1 Ass Q Io.RIGID PEAS"rIC - ( 1 y) ` ' <br /> VIII, CORROSIONPROTECTION 99 oiHLa sxrir 4490 <br /> ,400. <br /> STf:GI.COMPONENT PROT'ECT'ION ❑ Z.SACRo-ICinL nNOUIiLs <br /> ❑ 4.IMPRGSSEU CUI%REN'f ❑ 4 ISOLn ZION <br /> IX: APPLICANT SIGNATURE [ 44a <br /> CERTIFICA'I'IO:V: I certify that [his�ll" eflanc Js compatihlc rritll Ih0 huarJous substance stored ood thnl the InformalioD pruviJeJ herein is free, <br /> aecurnte,anJ(n 11 cum Ilnnce»its Ie al re ulrenr0nh. <br /> APPLICANT SIGNA7URG <br /> APPLICANT NAME(pDATErin T � no <br /> - { � rrf' APPLICAN'I'TITLG 'J <br /> 471. <br /> urcr'UST-111 Rev.(12/2007)-172 <br /> 4vwsv.111lidots.urg <br />