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AML- <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> =UNDERGROUND STORAGE TANKS -TANK PAGE 1 ' <br /> (Mro pages par to <br /> Page _ of <br /> TYPE OF ACTION 01.NEW SITE PERMIT D 4. AMENDED PERMITS. CHANGE OF INFORMATION) 0 B. TEMPORARY SITE CLOSURE <br /> (Check one Aem only) // `` 13 ]. PERMANENTLY CLOSED ON SITE <br /> 113.RENEWAL PERMIT (SP�ky mason.kr)pr,.al uae onry) lSpsaly rJenge-brlmal uss aMy) 0 S. TANKREMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME.,DBA-Doing Business As) FACRJTY ID R 1 <br /> "yt) r e--S c <br /> LOCATION WITHIN SITE(Optkre9 431 <br /> I.TANK DESCRIPTION <br /> TANK 10 Is ` TANK MANUFACTURER GOMPARTMENTALI2ED TANK ❑ Yes 0 No <br /> II'Yai,complete one page for earA wmpadmem. <br /> DATE INSTALLED TANKCAPACITYIN GALLONS NUMBER OF COMPARTMENTS <br /> � - / 49` � OOO <br /> ADDITIONAL DESCRIPTION(Forlowl me-*W <br /> 11.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> ❑ 1. MOTOR VEHICLE FUEL ❑ta. REGULAR UNLEADED D 2. LEADED ❑ S. JET FUEL <br /> (IlmeMeq wmpbb PefroMpm Type)Q� EMIUM UNLEADED ❑ 3. DIESEL ❑ fi. AVIATION FUEL <br /> ❑ 2. NON-FUEL PETROLEUM 1c, MIDGRADEUNLEADED 0 4. GASOHOL 099. OTHER <br /> ❑ 3.CHEMICAL PRODUCT COMMON NAME(hem Hazardous Materials Inwnkrypage) CAS N(Imm HazsNous Materials Imem.Wpage) <br /> ❑ 4. HAZARDOUS WASTE(Iodurias <br /> Used 0" <br /> 95 UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL W1TM 0 S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> (Check one dam Doha ❑ 2. DOUBLE WALL ❑ d.SINGLE WALL IN A VAULT <br /> [199. OTHER <br /> TANK MATERIAL-primary Mnk ❑ 1 BARE STEEL ❑ 3. FIBERGIASSIPIASTIC ❑ 5. CONCRETE 095. UNKNOWN <br /> (Check one Ore only) ❑ 2. STAINLESS STEEL C 4. STEEL CLAD PLASTIC 08, FRP COMPATIBLE W7100%METHANOL ❑99. OTHER <br /> REINFORCED <br /> TANK MATERIAL-sawndary lank ❑ 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC 0 e. FRP COMPATIBLE W1100%METHANOL C95. UNKNOWN <br /> (Checkmedemomy) ❑ 2. STAINLESS STEEL 0 4, STEEL CLAD PIUSTICGI-ASS 0 9 . FRP NON-CORRODIBLE JACKET _ 099. OTHER <br /> ❑10. COATED STEEL <br /> ❑ 5. CONCRETE <br /> OATEINSTALLED <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED 113. EPDXY LINING ❑ 5. GLASS LINING 0 9. UNKNOWN433 <br /> OR COATING <br /> ❑ 2.ALKYD LINING ❑ d. PHENOLIC LINING ❑ 6. UNLINED 99. OTHER FozlwaI use only) <br /> Check arae iIs onl) DATE INSTALLED <br /> OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 <br /> PROTECTION APPUCABLE PROTECTION <br /> ❑ d. IMPRESSED CURRENT ❑99. OTHER (Falowluse only) <br /> (Check ones ft.. ❑ 2. SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(For kcal use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Check aha that apply) ❑ 1 SPILL CONTAINMENT ❑ 1. ALARM �_ ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE 0 2. SALL FLOAT 0 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> N:TANK LEAN DETECTION <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER(Dheck one item only): <br /> IF SINGLE WALL TANK(Check ea that e <br /> ❑ 1, VISUAL(E(POSED PORTION ONLY) 0 S. MANUAL TANK GAUGING INTO) - 0 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 5. VADOSEZONE 0 2. CONTINUOUS INTERSTITIAL MONITORING <br /> 0 3, CONDNUOUSATG 0 T. GROUNDWATER 0 3. MANUALMONITORING <br /> 0 d. STATISTICAL INVENTORY RECONCILIATION(SIR) 0 8. TANKTESTING <br /> BIENNIAL TANK TESTING 099. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATEDDATE G (YRIMOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? <br /> gallons 0 Yea ❑No <br /> f <br /> CUPAFORM(4199) • . ! `11`(� a/0"drty CB Form 9 <br />