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06/26/2012 TUE 10119 FAX 705206 ®003/005 is UNOIED PROGRAM CONSOLIDATED FORM Il Z8 JL UNDERGROUND STORAGE TANK I'L vr- OPERATING PERMIT APPLICATION-TANK INFORMATION(one formper UST). TYPE OFACTION (Chxk gmitml only. For an UST p&Mnentelosuns or removal,complain only this seclionend5mllonel,I1,111jIXbelow) 410 ® I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANCE OF INFORMATION 6.TEMPORARYUST CLOSURE ❑ 7.USTPBRMANENTCIOSI)RE ON SITE Q 6.UST REMOVAL DATE UST PERMANENTLY CLOSED: DATE EXISTING USTDISCOVRRRD: 4wb �� C �I ;y.\T' v' ♦ , -It;)an.' ' 1•""P,Ithd '�i'�• i '!l.:a% ' . .. e..5��'+' f' '.(� .�t�I" -+,R,", 1 t,lf. :.il N•a � J. FACILITY ID 0(Agency Use On(v) i`',"�.:i` .F: ;r• y .it. 13USINBSS NAME(Same as FACILITYNAMB or DBA-Doing Business AP) 1 Spirit(3asoline BUSINESS SITE ADDRESS 7sa CITY 1°4 1250 North Wilson WayStaddon .t :.'�: ;h ! •�.` Ott ; ..t ° A4i.Ny.d :'.'• 27::.EX''e3n'f?.}�Slit,'rl.+a'.,Ift 1 fl. TANK ID#Tank 1-Unleaded 471 TANKMANUFACTURER. 477 TANK CONFIGURATION: THIS TANK IS 49" Modem Welding 01.A STAND-ALONE TANK 7A 0505 j'Jr�� ❑2.ONE IN A COMPMTMBNInn UNrr. C mw r 4ENTeD sauna. DAT ST SYSTEM INSTALLED 413 TANKCAPACITY IN OALLONS 4w NUMBER OF COMPARTMENTS IN THE if 471 4/1/95 15000 k 1 ',35' titi sIIV;T' {' 'a . �l'n' iY•J...il;: nA"A :zL.l:If•• TANK USE a I1.M8TORVBHICLE PUELINU O Ib,MARINA FUELING ❑ 1&AVIATION FUSLINU , , 470 Cl 3.*MMICALPRODUCTSTORAOE 0 4.HAZARDOUS WASTE Vrc dm U4e4Ui0 Q S.EMERGENCY GENERATOR FUEL(HOC 477717.3(:)1 O QOTRw GONRRA'(ORPUOL O 95.UNKNOWN [399.OTHER ec' t 4391 CONTENT$ PETROLEUM: ® 1a REGULAR UNLEADED 4 IaMIDORAOB UNLL4AbED [3Ib.PRB641UM UNLEADED 449 1] 3.D16381. ❑ LIST FUEL Q &AVIATION GAS E.PETROLEUM BLEND I1UOL 09.07TBR PETROLEUM eei : 4401 NON-PBTROLHUMt U 7.USED 0[L ij 10.ETHANOL 11.OTHER NON-PUTROLBUM(SPCOIf �} q0b + r -t•: 71y .✓L+u,('9.rT. .I. S :3Pi4<. . .��.... +S".i�.'it•"t,'.�'.4Lf•.•hJJ ` '' �IE,Y�•�{$lf:� t:'�Y'.�i'il.. TYPEOPTANK ' I.SINGLBWALL in 7,00V91,E ALL U 95.UNKNOWN 4a PRI MARYCONI•AINMENT 10 1.STEEL Q 3.11BER43LAS9 U 6.1NTERNALWADDER 11 ❑ 7.STISEL 4 INTERNAL MNINO ❑ 95.UNKNOWN O 99.OT316R el 444° SECONDARY CONTAINMENT 1.Mt. 3.FIBBRGLASS 6.EXTERIOR MEMBRANE LINER ].JACKETED IIS p 90.NONE 9f.UNKNOWN O 99.OTHER sol 4431 OVERPILLPREVENTION 1.AUDBLEAVISUAL ALARMS ].FALL FLOAT 3.PILL TUBE SHUT•OFPVALVE 157• O 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVIOMLI,PREVENTION EQUIPMENT PIPING CONSTRUCTION ❑1.9MOL&WALLHD ®2.DOrBLB-WALLED ❑99.OTFBR 4w SYSTEM TYPE 99 1.PRESSURE U 7.GRAVfrY 3.CONVBNTIONAI,SUCTION 4,SAPESUCTt0N CCR 63 01 431 PRIMARY CONTAINMENT 1.STEEL 4.PIREROLASS U A.FLEXIBLE U 10.RIGID PLASTIC 464 O 90,NONE O 95.UNKNOWN Q 99.OTJBR i t 4641 SECONDARYCONTAINMENT 1.STEEL 4.PWIMULASS Li A.FLEXIBLE 13 10.R1010PLASTIC 464 O 90.NONE O 9f.UNKNOWN O 99.OTHER(Swift 4649 PIP)NO/fURBINECONTATNMENT SUMP TYPE Q I.SINGLEWALL R9 2.DOUBLE WALL Q 90.NONE 4144 x' 1R tfi ;1Pi'AVIa�`O3NA:1 VENT PRIMARY CONTAINMENT I.STEEL 4,PIBEROLA99 tu.RIGIDPLASTIC 90.NONE 99.OTImR(Spec I ly) 1641 16111 VENT SECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS Ia RIGID PLASTIC 90.NONE 99.OTHER(Sp4clly) 464f lam VR PRIMARY CONTAINMENT 0 1.STEEL 0 4.PBEROLASS 0 10.RIGID PLASTIC 0 90.NOM: Ij 99.OTIfBR(bysaify) <us 4y I VR SECONDARY CONTAINMENT Lj 1.STEEL 0 4.PIEERGLASS Q 10.RIGIDPLASTIC Q 90.NONE 0 99,OTHER(Spwify) 464hr VENT PIPING TRANSITION SUMP TYPE IJ 1.SINGLEWALL 112.DOUBLE WALL 90.NONE 4646 RISER PRIMARY CONTAINMENT U I.STEEL 29 4.PIBEKOLASS U IM RIGID PLASTIC P11 90.NONB U99.OTf1ER(Spmllyj / RISER SECONDARY CONTAINMENT t3 1.STEEL 0 4.FIBERGLASS 0 I6.RMIDPLASTIC 0 90.NONE LJ 99.OTH5R(*0Iry) /6/e 4611 FILL COMPONENTS INSTALLED 99 1.S��P��,II,rLr{LB��U3}}C�}}Krr,,�S6��T,,��,,QQ�®�'}3.STR,I6K�yE�R PLATEMMOM PROTECTOR 4.CONTAINMENT SUMP 441°-0 . . :1:!f,KMR4A .PI43..A.t4 V ( •t•' .t, i4• �+I,' 1'`. CONSTRUCTION TYPE ® I.SINGLE WALL O 2.DUUBLB WALL O 3.NO WSPONSERS O 90.NONE 40, CONSTRUCTIONMATERIAL Q I.STEEL Q9 4.FMERGLASS__13 10.RIGID PLASTIC 99.07H111`7S 45%4 STEEL COMPONENT PROTBCTION Q 2,SACRIPI13ALANODP.(S) Q 4.IMPRESSED CURRENT 0 6,ISULATKON 446. CERTIFICATIONI i certify that lids UST system Is compatible with the haurdous substance slorad And that the Inflrmaden provided heron Is tragi,AceurAte, and In NII compliance with legal rtitulrements, APPLICANT SIGNATURE DATE O O 419. O APPLICANTNAMB(prinl) 7DginderLAI q71' APPLICANTITTLE Operator /13' UPCP UST-B-112 �\ Hey.(1214007)