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Ank <br /> UN FIED PROGRAM CONSOLIDATED M ( � <br /> r NKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1� (MN <br /> Pape 1 W 2 <br /> ❑ S. CHANGE OF INFORMATION) <br /> ❑ S. TEMPORARY SITE CLOSURE <br /> TYPE OF ACTION ❑1. NEW SITE PERMIT ❑ �- AMENDED PERMR � 7, PERMANENTLY CLOSED ON SITE <br /> (Check one own only) AAAA AvbW VU Wy1.) ❑ B. TANK REMOVED 430 <br /> (N 7. RENEWAL PERMIT ( ,�apn AX pry YM aWyI ISpedN Na^9e. I <br /> BuN mNl ] FA ------ Y: <br /> BUSINESS NAME(Sant u FACILITY NAME aDBA-Ooaq 11 <br /> My Mini Mart '71 <br /> LDcnrwN vnrHlN snE(OWbnW) <br /> `.L TANK DESCRIPTION <br /> TANK IDY 472 TANKMANUFACTURER 433 COMPARTMEMu',ED TANK olio pap MMVurJt ConW190WK• 434 <br /> 2 Joor Manufacturing u7 <br /> DATE INSTALLED(VEAtLA1 1 <br /> 175 TANK CAPACfTV IN GALLONS 43Y NUMBER OF COMPARTMENTS <br /> 5/99 C1.000 O 470 <br /> ADDmONAL DE9CRIPTKNI(Fw pW uu 0*) <br /> B.TANK CONTENTS440 <br /> '. <br /> TANK USE 430 PETROLEUM TYPE _ 0 5. JET FUEL <br /> CSI 1. MOTOR VEHICLE FUEL SI I, REGULAR UNLEADED ❑ 2. LEADED <br /> Pabopwn Type) 10. PREMIUM UNLEADED 0 7. DIESEL 0 e. AVIATION FUEL <br /> (X maMad,omnplWa ❑99. OTHER <br /> 0 2, NON-FUEL PETROLEUM 01a MIDGRADE UNLEADED 0 4. GASOHOL <br /> 0 7. CHEMICAL PRODUCT COMMON NAME @om Harwooua MWWWs Im IOIYPWS) MI CAB(Ilom Hazanpus MalanWs Imenlory pope) N2 <br /> 0 4. HAZARDOUS WASTE(Indu*S <br /> Used OF) <br /> ❑95. UNKNOWN <br /> --------------- <br /> M.TANK CONSTRUCTION:. <br /> n <br /> K 01 SIHERE WALL ❑ 3. SINGLE WALL WITH0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM M0 <br /> 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWNm WIY) 0 4. SINGLE WALL IN A VAULT 0 99, OTHER <br /> LTMK <br /> ATERIAL-pAmalY unK 0 ]. FIBER GU SS I PLASTIC 0 5. CONCRETE 095. UNKNOWN 44d <br /> ❑ 1. BARE STEEL <br /> aneH pnM Cl 2. STAINLESS STEEL EIB. STEEL LAD 0 B. FRP COMPATIBLE WII 00%METHANOL <br /> Cl So. OTHER <br /> REINFORCED PLASTIC FRP <br /> ATERWL-aemMery bnk 0 1, BARE STEEL 07. FIBERGLASS I PLASTIC 0 S. FRP COMPATIBLE W/100%METHANOL ❑95. UNKNOWN N5 <br /> ons oem Wyy) Cl 2. STAWlE3357EEL 0 4. STEEL CLAD WIFIBERGLASS 0 9. FRP NON.CORRODIBLE JACKET 099. OTHER <br /> REINFORCED PLASTIC(FRP) 010. COATED STEEL <br /> ❑ 5. CONCRETE <br /> DATE INSTALLED K7 ' <br /> TANK INTERIOR LINING 0 1, RUBBER LINED 03. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN 448 <br /> OR COATING0 2.ALKYD LINING ❑ L PHENOLIC LINING ®S. UNLINED 099. OTHER FW bbl use <br /> ChKk meoam DATEINSTALLED 119 <br /> OTHER CORROSION Cl 1. MANUFACTURED CATHODIC XY7. FIBERGLASS REINFORCED FUSTIC 095. UNKNOWN 46B <br /> PROTECTIONIFAPPLICABLE PROTECTION 04. IMPRESSED CURRENT ❑9B. OTHER (FW 1WAY we Wy.) <br /> (ChM A ono dem u1Ny) 0 2. SACRIFICIAL ANODE 151 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> SPILL AND OVERFILL YEAR INSTALLED 450 TYPE IForpW use MY) <br /> 1O[7p(]p(] ® 1 ALARM KI ]. FILL TUBE SHUT OFF VALVE__ <br /> (Check at Mal apply/ CSI 1. SPILL CONTAINMENT 1999 <br /> � Z. DROP TUBE 1999 � Z. BALL FLOAT ❑ 1. EXEMPT <br /> 7. STRIKER PLATE 1999 <br /> N. TANK LEAK DETECTION <br /> 157 IF DDUBLL WALL TANK OR TANK WRN BLADDBR(Check orM osm oNy): 151 <br /> IF SINGLE WALL TANK(CAarkY IMI wp+Y): <br /> Cl 1, VISUAL(EXPOSED PORTION ONLY) 0 5, MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 0 9. VADOSE ZONE 2. CONTINUOUS INTERSTITIAL MONITORING <br /> 2. AUTOMATIC TANK GAUGING(ATG) <br /> 7. MANUAL MONITORING <br /> 0 7, CONTWIJOUSATG 0 7. GROUNDWATER ❑ <br /> Cl 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• Cl B. TANK TESTING <br /> BIENNIAL TANK TESTING Cl 9o. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 157 <br /> ESTIMATED DATE LAST USED(YRIMOIDAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 458 TANK FILLED WITH INERT MATERIAL7 <br /> asoana 0 Yu 0 No <br /> • / Formally SWRCS FORn B <br /> UPCF(1199) <br />