Laserfiche WebLink
bk <br /> NIFIED PROGRAM CONSOLIDATED FOR <br /> TItank) <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> (Mn pag <br /> Page _ of _ <br /> 11 S. TEMPORARY SITE CLOSURE <br /> TYPE OF ACTION 01.NEW SITE PERMIT 04.AMENDED PERMIT ❑ S.CRANGEOFINFORMATION) 07PERMANENTLY CLOSED ON SITE <br /> (Check ons gem only) <br /> ❑3.RENEWAL PERMIT (SpeoYynnon-brbiluasony) (Spedi)targe-hrbcaf uu oraw ❑ B.TANKREMOVED 430 <br /> FACILITY IDs 'i` <br /> BUSINESS NAME(Sema as FACILITY NAME or DBA-Ddng Bushnu Aa) y9. <br /> �10 <br /> 713 ' <br /> LOCATION VATHIN SITE(Op5one9 �I '►1 ' <br /> 1.TANK DESCRIPTION <br /> TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Y <br /> TANK IDs es <br /> o <br /> S � � � �` COMP,implele one page for ead imPam ant. <br /> TANN CAPACITY IN GALLANS NUMBER OF COMPARTMENTS <br /> DATE INSTALLED(YEARIMO) <br /> ADDITIONAL DESCRIPTION(Forkk:al u»OKIW <br /> 11 TANKCONTENTS <br /> TANK USE - 432 PETROLEUM TYPE [15. JET FUEL <br /> 5.1.MOTOR VEHICLE FUEL �Va. REGULAR UNLEADED [12. LEADED B.AVIATION FUEL <br /> (it marked,complete Petmbum Type) �3E. PREMIUM UNLEADED ❑ 3. DIESEL � . OTHER <br /> ❑ 2.NON-FUELPETROLEUM [2 Ip MIDGRADE UNLEADED ❑ 4.GASOHOL <br /> 0.❑ 3.CHEMICAL PROOUCT CAS a(tmm HalsNa,Mabdals tmwntmpsge) <br /> GAMMON NAME(/nm Haxanlous Mabriela Invanforypa9a) <br /> ❑ 4. HAZARDOUS WASTE(/ndudes <br /> Uud Dg <br /> "11L TANK CONSTRUCTION <br /> TYPE OF TANK ❑ I, SINGLE WALL ❑ 3.SINGLE WALL VATH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> ry� EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> (Check we item OnW 1�. DOUBLEWALL 04_SINGLE WALL IN A VAULT ❑99.OTHER <br /> TANK MATERIAL-pQmery tank 3. SARIN STEEL K3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN <br /> ❑ <br /> (Check one item oMy) ❑ 2. STAINLESS STEEL ❑4. STEEL CLAD tASERGLASS ❑ B. FRP COMPATIBLE W/100%METHANOL ❑89. OTHER <br /> ' ss REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-aainda^y tank 1, BARE STEEL 1t7Q. FIBERGLASSIPLASTG [IB. FRPCOMPATIBLEW/WO%METHANOL ❑95. UNKNOWN <br /> (Check one from or w ❑ 2. STAINLESS STEEL 0 4, STEEREINFORCED IRBEERCGLAS0 9. FRP FRPS 0 W.COATED STEEL JACKET ❑99.OTHER <br /> ❑ 5. CONCRETE <br /> DATE INSTALLED <br /> TANK INTERIOR LINING 1, RUBBER lINEO ❑ 3. EPDXY LINING <br /> ❑ 5. GLASS LINING 95. UNKNOWN433 <br /> OR COATING PHENOLIC LINING DkUNUNEO ❑99. OTHER <br /> ❑ 2.ALKYD LINING 4, PHEFartecel use Pnl <br /> CtrcX orn(romaGATE INSTALLED <br /> OTHER CORROSION ❑ 3. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 <br /> PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSEDCURRENT ❑99.OTHER <br /> (Forboal use only) <br /> (Check one item only) ❑ 2. SACRIFICIAL ANODE. OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> SPILLANDOVERRU. YEARINSTALLED TYPE(Forbin ma oNy) <br /> (Chackatlthatapply) SPILL CONTAINMENT ❑ t ALARM __ 3. FILL TUBE SHUT OFF VALVE <br /> 9�2. DROPTUBE El 2, BALL FLOAT D C EXEMPT <br /> iJ. STRIKER PLATE <br /> ;IV.TANK LEAK DETECTION <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER Check one item only)' <br /> IF SINGLE WALL TANK Check eg theta I <br /> ❑ 5. MANUAL TANK GAUGING(MTG) ❑ I. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ I, VISUAL(EXPOSED PORTION ONLY) ❑ 2. CONTINUOUSINTERSTITIAL MONITORING ' <br /> 2. AUTOMATIC TANK GAUGING(ATG) ❑ 8. VADOSE ZONE <br /> ❑ 3. CONVNUOUSATG. ❑ T. GROUNDWATER ❑ 3. MANUALMONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑ S. TANKTESTING <br /> BIENNIAL TANK TESTING ❑g9. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRIMO/OAYI <br /> ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? <br /> gallons ❑Yea ❑No <br /> Formerly SWRCID Form B <br /> CUPAFORM(4/99) <br />