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D �r Z61�z w�- ►���.�'l�l �- <br /> UNIEIED PR <br /> CONSOLIDATED FOR <br /> UNDERGROUNDSTORAGETANK n <br /> TYPE OF ACTION OPERATING PERMIT APPLICATIO "�� <br /> NEW PERMIT(f �eilea only tiwa US c/m, or N-TANK II I RMATIO <br /> El ranom(coap/ele on/y(h/lea(lon nndSeclipu///qj/p.mM/A,�/01N (One form per USxi <br /> 0.TEMPORARY USTCLOSURE 3.RENEWAL PF,RMIT <br /> UA'IE UST PERMnNEMiY 7.UST PC•RMANCNi CI,pSURE ON ITE S13 S.CHANGE OF INFORMATION <br /> CLOSED: R.USTREMOVAL <br /> UATr HXIS ZING US F DISCOVERED: <br /> FncIUTYIDa(gReryU,eonry) I• 'FACILITYINFORiKATION" as <br /> BUSINESS NAME(Snaem Pnei/hy Nrtea orD9A-L)oing AlalxuAs) - - <br /> J. <br /> BUSINESS SITE ADDRESS CQ Q <br /> s. <br /> C IW. <br /> I NK IDs TANK MANNI- TANXI)ESCRIPTION <br /> ^ 912 UFACTURER <br /> L ^9y(� I +s). TANK CONFIGURATION.'rHISTANK IS <br /> DALE USTS S--p STALLED +JS. �" - " ""116aA O 1AST NO ALONE:TANK rs4 <br /> �rw�c TANK CAPACITY IN GALLONS 4J6. 2.0 IINA COMPARTM• 0""W"r 0'e ws°r r+ra <br /> NUMBER 01+COMPAN'I'M.....I N I'IIG UNI'r� the 4I7. <br /> TANK use III. TANK USE c- <br /> 0le MOTOR VEHICLE rUCLING AND CONTENTS`. <br /> ❑ 3-CHEMICAL PRODULTSR GE IA MAR INA FUELING <br /> �_6.011{PA GENERATOR FUFI, 0 4.HAZARDOUS WASTE Unyp SIC AVIATION FULLING <br /> C.ONTENrS PETROLEUM: �' _ ---0 9S.UNKNOWN ) ❑S.EMERGENCYONF FULLING <br /> n9. <br /> ❑ ly.REGULAR UNLEADED -.-_0 S. T :GENERATOR FULL RISC g252813(,H <br /> ❑7.DIESEL OIc.MIOGRADEUM.EADED p_--'_A" o!W: 13h <br /> -- -- QS,PETR ❑ S.JhPFUEL �ib.PRRMIUM UNLEADED <br /> NON-PRTROLEW --7.USEDpUM BLEND FUFl. -..__ --.._ ❑6.AVIATION GAS r4n <br /> ❑9.O17{ER 1'FTROLJIUM(SEedfY)_ <br /> 11.0'INIi R NOMP, OIEUM $ O'f U.H7NANOL +994 <br /> TYPEOFTANK ZY*':TANK CONST U 44eq -. ...._.._ <br /> PRIMARY CONTAINMETfP '-S)NGLe WgLL ❑2DOUB <br /> STEEL LE WALL O 9s CNK �vN <br /> .STEEL+1 ❑LINING ❑6.INTER NAL eLADDLR '-- _ 441. <br /> SECONDARYCONTAINMF.NT ❑ I,STEEL M�ERNAL LINING --�95.UNKNOWN_ ' <br /> ❑7.FIBERGLASS (]99_OTHER q4. <br /> NONE ❑4FJEIERIOR MRMORANE LINER ���� 444L <br /> OVERFILL PRF,VENI'ION -- _ O95.UNKNOWN__-[199.IyN1ER5 j.-j, <br /> ❑ I AUDIBLE Q VISUAL ALAR ME ❑x.HALL AT <br /> f pedfy)o - 445. <br /> ❑ aTAYK MLETSR RBMEMS FOR LXFMPTION FROMOV: ❑J.FILL TVBESHIIr-0pF VA1,VD <br /> .:. �/. PR D /.` LAFILL PRRVEMIONp UIPMLRJT .. .45L <br /> _PIPING CONSIRUC17pN Y WA$TE'kjpA�'G:CONINIus ION <br /> SYSTEM TYPE -"'---'�I SmGLE WM L _ <br /> ❑ x.IJOUOLH wgu._O 99 DATER �r x �:• . <br /> PRIMARYCONTAtNMENT QL racSSURE_�,�__�.1,�, <br /> 4.OBAV -(�j CGNVEMYONAL SUCTION <br /> '� STLFL ❑4.FIHBRGLASS ❑0.SAFE SU 4Qp' <br /> ❑90.NONE 11 95�UMCNOWN ❑S.FLEXIBLE ---"-' ._-._ ON W ttk 41H6(s)Isu 4% <br /> SLCONDANY CONTAINMENT ❑ 1.ST1?DL 13 99.OTHER ❑ IO.RIGID PLASTIC'-- <br /> ❑4.FIBERGLASS (S'xRy� ' <br /> ------- ___. 0 NONE: ❑95.UNKNOWN �S.FLRXIDhB 4Wy <br /> PIPINGfTI1RBINE CONINNMENT SUMP TYPE -- ❑99.0T51rd1 ❑ 10.RIGID PLASTIC -"- - <br /> ❑ I SINGLE WALL - (�s"'t. 4ub. <br /> 9D+NONE <br /> VI. VENT, VAPOR x DOUBLE WALL 6 r <br /> RECOVERY(VR)AND RISER''FILL`PIPE PIPING CONSTRUCTION <br /> VF-NT PRIMARY CONfA1NMENT 1O9tl <br /> VE - 1,STRr.I <br /> VENTSFCONDARY CONTAINMENT + FIBERCLnSs <br /> .._ ❑ 10.RIGID.... IC <br /> ------- _____ ❑ 1 STGGL ❑ 1.FIBERGLASS 0 90.NONE ❑ 99.OT'IIER(Speeiry7 <br /> -vi-PRIMA RY CONTAINMENT �� ❑ IO.RICID PLASTIC <br /> _ ..__.._,__-_____-. F ?Q NONL_ <br /> _._ ❑ 1.5rEf•.1 ❑4 FIBERGLASS ❑99.OTFIkR(Sped +a <br /> VR SECONDARYCONI'AINMENT <br /> -�-- ---- ❑ 10.RIGID PLASIT <br /> ❑ <IIBERGLASS 0 90 NONE ❑99 OTHER(Specify); i <br /> VENTPIPING TRANSITION SUMP'TYPr - __ _ " <br /> _ �-" ❑ 10.RN710IM.ASTIC ----"--` <br /> -.._ 9D NONE -' ' . <br /> ❑ L BINDLE WALL ❑i DOUBLE WALL �QO NONE .❑ 99.OTfIL•R(Spedfy)• +46r I <br /> RISERPRIMARY CONTAINMENT _. -- --- ._ <br /> RISER SC•CONDARY CONTAINMENT O4.FIBERGLASS -7Zi'- <br /> ❑ 10.RIGID PLASTIC 90.NONL' . <br /> FILL COMPONENTS INSTALLED ''STEEL ❑4.F'IBEROLA.SS l9.RIGID pLnSTiC 0 99 071nIGR(Spmify): - 4a4y <br /> ' Q L SPILL BUCKET NONE ❑ 99 0111-R(Spedly); qs4'' <br /> ❑ 3 STRIKfR PLATLA}0'rl'OM PROTECTOR ❑ 4,LONIAINMPNTSUMP 4 Ac <br /> VII. UNDER DISPE <br /> CONSreuC I ION rrv); NSER CONTAINMENT(UDC) <br /> CONSTRUCIIONMAI'rRIgL '- I SINGLE tVALL _ <br /> ❑ I S71-IeL ❑ LFIBERGLASS--9-��UDLE IYALL_ ❑ ] NO UISILNSFItS I 90 HONG acm. <br /> ❑ 10.RIGID PLASTIC ❑ 99.0'i'HER(SPccify) - u9p- <br /> srrrLCOM PONENTPRO I'LCfION VIII. CORROSION PROTECTION x <br /> ❑ 3.SACRIFICIAL ANOUG.S <br /> _ _ ❑4.IMPRfSS[D('(1RRLNr <br /> IX. APPLICANT SIGNATURE c Iso nuDN <br /> CERTIFICATION: (certify Ihyt this UST syslmn Is compatible with Ile IIR),ardoin subslan<e stored and Thal the Information provided herein is true, <br /> accurate an in full nce wllh Ie <br /> APPLICANTSIGNATURC n1laal rulre(too, <br /> APPLICANT NAME(prinQ DATE <br /> N ZIT -3 -! m <br /> APPLICANT TITLE <br /> UPCF USI'-R Ray.(I W007) 0 -4 <br /> "W.anidoes.orR ` ll <br />