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vO/LU/2012 TUE 91 09 FAX X095/005 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERCROUNDSTORACETANK <br /> OPERATING PERMIT APPLICATION-TANK ROTATION OAe fmm U <br /> 'Y <br /> OF ACT1pN (CTreek mm Rem 0*' FOr en USrPxmenODt m7em0ve1,Complete only thle m4Gon and eectkmeLE.IS,N,en I w) ♦Yo <br /> ® I.NSW PSF1A31T 3.RENEWAL PERMIT ❑ S.CHANGfi OF INFORMATIOjd <br /> 6. PORARYUSTCLOSURE 7,USTP REONSITE B.U8TREMOVAL <br /> DATA UST PERMANENTLY CLOSED: DATE EXISTING UST DISCOVERED: <br /> FACILITYN(As'++KY <br /> EUSE4155S NAME(Berne e7 FACILITY NAME m DEA•Doing RiWnrq A4) <br /> Spirit Gasoline <br /> BUEIN848 81TB ADDRSBS103 CITY ju <br /> 1250 North Wilson WR Stogy <br /> 1AWK ID N Tank 3-PTeminm IANILMANUM a TANK ODNPIGURA'DON:THNTANK I3 414 <br /> Tq D ModornWelding ® LA STAND-ALCNETANK <br /> 13 3•on R4 A u9mpm7A9eNreo UNIT. <br /> DATE LIST SYSTEM IN TA + INOALLONS 0 NUMEBRMAR IN THRUNIT <br /> 4/1/95 12000 <br /> MMA <br /> -TARR tj a MOTOR VBHtr•rw PUB LM U Ie.MARINAPV&.RN3 , ❑ In AVIA7IDNHYMANG <br /> Q 3.CHIMMALPAODUCTITORA00 134.HAZARDOUS WASTB(T.dedo Und Ow C35.EMBROONCY OVSKATOR PURLIUM troll 5(.)] <br /> b.D'C31PROffi4 TOR INE, 93.UNKNOWN ❑ 99.on= 4N. <br /> CORT mm PHTROLEIIM: p XLBIDU1ARUNUADED XP.MID(RADIUNLEADBD ® TPREAUUMUNLEADED <br /> ❑ 7.t3lum p 1 Mr FUEL ❑ 4,AYIATION OAS <br /> S.PRIAOLIRBA 1)MDNEL 111,OTHER PBTROLSUN 444. <br /> IeOf4 if ROLWA& T.USE 0 Q 10,InIiANOL <br /> 11,O'1•HBRN(R•7•PETROLBUM 4406 <br /> TYPE TA 1.RINGLB WALL 2.DOUBfe WALL 95.UN <br /> PRIMARY OOMADR91BIrI 1.UIEBL 4M <br /> R 3 p 6.RiiRRNALDLADDO<l <br /> T.STEELi-INTEPtHALLINING C7 ".UNKNOWN 0 9P. 444. <br /> SECONDARY CONTAINMENT Lj l,STIBI 19 3.PEURULA99 b.BXRBPIORMRMBRANEIINER 13 7JACKISM 447 <br /> 90,NONII ql.I1NKNOWN 99.Ory{gAaWh <br /> OVERFI N AVAOALALAIWB 2.BALL LOA ab. <br /> 4,TANK MEM REWrRIIHONTS FOR W PAPTION FROM OVBRHLLPRBVRWnON IGUIPMENT <br /> HMNG CONSTRUCTION 1 A1,41SU VNtVULHILWWALLED U99.01. 40 <br /> I.PRRgm B Q 2,01RAVITY 3.0ONV TX L 4.FVSEL-MN Wt <br /> vgm An <br /> PRIMARY CONTADMaNr U I.grout, 0 CMEROLASS e.PI73KIELB I0. nA 4s4 <br /> 99.NW 95.UNKNOWN p 99.0 �. <br /> SECONDARY COMAXNMENT 1 4.PIDBROLABS RPLBKIBLA ]p, C <br /> iC3 9o,NONE Cl 95,UNKNOWN 9 <br /> HPI AINMRNTSIMPTYPE I.SINOLEW M <br /> I . , N <br /> VRHT PPIMARY CONTAINMENT I.81TIm, 0. I 7'LA, C P0.NONE 9A OT[i[[R(SPkiIY) <br /> ♦44.1 <br /> VANTSOOONakYOONTAINMINIT 13 LPI». 0 4.r0D. aonA 99. E(sgrr;bY <br /> Yft PRXMARY ONTAINMfiNT L L 4.PIBffilGCABS 10. ID * ) <br /> VR aN 1 <br /> AY CONTAINMENT Cl I.MOL 10 1.11mmuss 10.AIOIDY{,ASTIC 90. BR( <br /> 13. 1 <br /> V P TRA P W <br /> S ARY OONIAXNMBN7 L8 4. LASE IARIDID 90, A <br /> RISBR MONDARV CONTAINMENT 0 1.8rBR1 a 4.FiMoVM U IQ RIOM FLATnC LJ 99.NONB 0 99.OTFtaKEppa 46 <br /> HLLILL BUCKT RBTNKB%YI.A P/S P /6nl <br /> . E <br /> � .. ARihSBN[SI7MP <br /> CONS vcmN TYPE I,SINOIE WALL 2.DOUILB WALL 3.NO DI�SPISBRB PD.NONe <br /> C MATERIAL 1.81TR3L ia 4, OLASS <br /> fO.RICm PLASTIC 11 99.0THER 114?♦ <br /> ' t• '�' x ,•J..2,'.9�:: I' G ' Vii: „ I ��' 'p•i',r 1 !Yi•. <br /> STEEL COMPONINTPROTSCIRM CI 2.EACAMA{,ANODE(S) D 4.IMPREBBBD CURRBNf <br /> D 0.ISOLAT(ON ut. <br /> + 'i.:., •,.' (•:' : .• ;, a §�'�ls.': 'b;,j,'t,f. ,,:' -.� ., ,: �':$.,`✓: f '.v � {{yy'' •IY"t6.J.. ..,�.: <br /> C/ATEPICATNNItIcaftth9tthkU9Tq/IMmheelopNblewith the bourd aanImMawasweanotRRtlNMMM mprVrMdherelnl7lrUf aA AN <br /> SAW In fall COM11finet with 1 <br /> APPLICANT SIGNATURE DATE <br /> APPLICANT NAME(vemg JogWaLal APPLICANT TITLE Operator <br /> UPCFUST-E-7/2 Rev.(17f70E'0 <br />