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bb4s O\ <br /> s- <br /> UNIFIED PROGRAM CONSOLIDATED FORM ��3\�y\°L1� TANKS <br /> UNDERGROUND.STORAGE TANKS-TANK PAGE I �1?00 p9paaper(ank) <br /> Papa _ of <br /> ❑ 5.CHANGE OF INFORMATION) ❑ S.TEMPORARY SITE CLOSURE <br /> TYPEOFACTION 34 3.NEW SITE PERMIT- [34.AMENDED PERMIT ❑T.PERMANENTLY CLOSED ON SITE <br /> (CNckom arm aM') S rinrgr-prpul vas PMS ❑ S.TANK REMOVED 430 <br /> ❑3.RENEWAL PERMIT (SpePYynaaw (ywb I <br /> FACILITY 108 <br /> BUSINESS NAME(U..ac FACILITY NAME ar DBA•Dquq <br /> 431 <br /> LOCATION WITHIN SITE(OPlpmp - <br /> L TANK DESCRIPTION <br /> TANK MANUFA/CTURER e- A�l�� COMPARiMEIMMe, p.a me Papa for raMlwmpaNnrnl <br /> TANK ID /. ..L'W^ � /,t aNl <br /> T�00155 Y TANK CAPACITY IN GALLONS d NUMBER OFCOMPARTMEN S T <br /> OAT E INSTALLEO(YEARRAO) <br /> 0 'T <br /> �;. _e 3.- <br /> ADDITIONAL DESCRIPTION(fatppal vaa onlr'1 <br /> ILTANKCONTENTS <br /> TANKUSE 432 PETROLEUM TYPE ❑ S.JET FUEL <br /> �I a. REGULAR UNLEADED ❑ 2.LEADED <br /> p�Ay I.MOTOR VEHICLE FUEL W3. DIESEL ❑ 8.AVIATION FUEL <br /> P//brr'w.comyNlr yrfMaum Typrl PREMIUM UNLEADED ❑89.OTHER <br /> ❑ 2.NON-FUELPETROLEUM [IIc MIOGRAOEUNLEADED ❑ 4.GASOHOL <br /> CAS 8(hom Mas+Noua MaM1Aala Inwnlorypape) <br /> ❑ 3.CHEMICAL PRODUCT COMMON NAME("m Nuam-I Maren4b pbnfpry paps) <br /> ❑ 4. HAZARDOUS WASTE(1Pe Se <br /> usM Oip <br /> n., INKNO'80 III.TANK CONSTRUCTION <br /> ❑ 1 SINGLEWALLWITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> TYPE Of TANK ❑ I.SINGLE WALL EXTERIOR MEMBRANE LINER 005. UNKNOWN <br /> (CArck om Bem eNy) 2. DOUBLEWALL ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER <br /> ❑95. UNKNOWN <br /> TANK MATERIAL-lt na MM ❑ L BAREStEEL �{21 PN 3. FIB ERGL.ASSIPL.ASTIC ❑ 5. CONCRETE <br /> ESSSTEEL ❑4. STEEL CLAD WIFIBERGLASS ❑ 8. FRP COMPATIBLE WI%W%METHANOL [:I". OTHER <br /> ❑ 2. STAINL <br /> (CArck om Sem oNy) REINFORCED PLASTIC(FRP) <br /> TANK MATERML-ercPnBarT W-K ❑ I. BARESTESL �3. FIB ERGI.ASSIPLASTIC ❑ B. FRP COMPATIBLE W/100X METHANOL ❑BB. OTHER <br /> (CAe<k..Ham aHyl ❑ Z. STAINLESS STEEL ❑ 4. STEEL CLADWIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET <br /> REI NFORCED PLASTIC(FRP) 010 COATED STEEL <br /> ❑ 5. CONCRETE DATE INSTALLED <br /> ❑ I.RUBBER LINED ❑ 3. EPDXYLINING ❑ 5.GLASSUNING El 95.UNKNOWN433 <br /> TANKINTERIORLINING ❑ S. UNLINED ❑89.OTHER Forlwrl me on 1 <br /> OR COATING ❑ 2 ALKYO LINING - ❑ 4. PHENOLICUNING <br /> GATE INSTALLED <br /> (Cllack Pm Sam 1 434 <br /> OTHERCORROSION ❑ I. MANUfACTUREOCATHOOIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑99. OTHER u��' (Forbcalua Pnyl <br /> PROTECTION IF APPUCABLE PROTECTION ❑ 4. IMPRESSEDCURRENT <br /> (CMFMamiNm yrxh ❑ 2.SACRIFICIAL ANOOvINSTALLEO TYPE(ForpW uaa oNy) OVERFILL PRauipnT:YEAR INSTALLED <br /> SpILLANDOVERFILL <br /> I.ALARM 3, FILLTUBE SNUT OFF VALVE <br /> (CIIeQ a21mlappM l6k1. SPILL_ 'XimEll <br /> �2. DROP TUBE pT..� [�J/,(�U ❑ 2. BALL FLOAT ❑ A. EXEMPT <br /> __ <br /> �Al3. STRIKER PLATE <br /> LEAKDETECTION .:.. <br /> IF DOUBLE WALL TANK 00.TANK WIT1 BLADDER CAeck one item any): <br /> IF SINGLE WALLTANK kOMla ) ❑ S. MANUALTANKGJUGING(MTG) ,❑./y VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 1. VISUAL(EXPOSEO PORTION ONLY) ❑ S. VAOOSEZONE tl 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑2 AUTOMATIC TANK GAUGING(ATG) ❑ p GROUNDWATER ❑ 3. MANUAL MONITORING <br /> ❑ 3. CONTINUOUS ATG ❑ S. TANKTESTING <br /> ❑ 4. STATISTICAL INVENTORY RECONGLIATION(SIR)e ❑� OTHER <br /> BIENNIAL TANK TESTING <br /> V.TANK CLOSURE INFORMATIONIPERMANENT CLOSURE IN PLACE <br /> 435 TANK FILLED WITH INERT MATERUV <br /> ESTIMATED DATE LAST USED[IFIMOIO.LYI ESTMATEDOWNTTY OF SUBSTANCE REMAINING <br /> paYana ❑Yu ❑No <br /> FOODerly SWRCS Form <br /> CUPAFORM(4198) _ <br />