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-- � UNIFIED PROGRAM CONSOLIDATED FO UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION (Oneform perUST) TYPE OF ACTION (Checkone nem onh'. For u bST closure or removal,complete onh.this section and Seenons I.II,III,If.and ff beloa9 430 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ S.CHANGE OF INFORMATION 6.MPORARY USI CLOSURE 7.UST FERhLANENT CLOSURE ON SITE 8.UST REMOVAL DATE UST PERI,LANENTLY CLOSED: - 1 D.aTE E-MSTING UST DISCOVERED: Ji1b I. FACILITY INFORMATION FACII.TII•m a 4-lgenc7-('se Onh.l - - BUSINESS NAME(Same as Fanhh•fume or DBd-Donrg Bnsm a. 3 Ivr > BUSINESS SITE ADDRESS m3 CITY- IL TANK DESCRIPTION TANII:m n 4.3. T�A1N�II�:N^ILA.NU'F�.a,Cf^�T�IJER 413 TANKCONFIGURATION:THIS TA 4K IS 4.J o5/58tt7 rnOQf.LA� /�V � 1ASIAN[1AtoNeT.ANR c.da.oa a.6 an /AV :.CBJEINAt'1')hPARTT.ENIEDIM cmtwe�wmWemt DATE UST SY STEM INGALLONS 4x. NLTMIBER OF L'OMPARTMENITS IN THE OMIT 43- e oa d o0 M. TANK USE AND CONTENTS TAW LTSE 9 to MOTOR VEHICLE FUELING O Ib.MARINA FUELING O Ic A\TATIONFUELING J19 3.CTIEMICAL PRODUCT STORAGE I] 4.HAZARDOUS WASTE(LrcJodslh,dOB ❑ 5.EMERGINCP GENERaTORFLTEL IBsa'.§25M sIe)I ❑6 OTHER GENERATi1R FUEL. _..__ [_95 UNI190RN . 0 99.OTHHER(SpecdS'). 43% CONTENT'S PETROLEUM ❑ I.REGL7.AR IMEA TIB ❑ k blDtiRA I._I.E.IDED 0 Ib PAEhIUMLINL.EADED 440 ®3 DIESEL. ❑ 5 EI FUEL. ❑6.AVIATIONGAS ❑ 8 PETROLEUM BLEJDFUEL ❑9 OTHERPETROLEUM(Specdp) NON-PETROLEUM 0 7 USED OIL 0 10 ETHLANOL 11 OTHELNON41ErR0LELm-[ r IV. TANK CONSTRUCTION TYPE OF TANK 0 1 SINGLE W.U.I. 0 DOUBLE WALL U 95 UNLNOWN u3. PRIMARY CONTAINMENT 1 STEEL, O 3.FIBERGLASS r) 6 INTERNAL BLADDER 7 STffT.+INTERNALLINING 95 UNLNORTL I1 99.OTHER •) 414a _ SECONDARY CONTAINMENT ❑ 1 STEELa FTF RGLASS 0 6.EKTM0R AEh16RANE LIER O 7 LACKETEI) Jam. I] 90.NONE 95 INMNOWN ❑99 OTHER 'i. NA - OVERFBL PREVENTION 0 1 MIDM E S\TSLLAL ALARMS ❑ 2 BALL FLOAT W FILL.TUBE MIVT-OFF VALVE 45= J.TAIWI iEETS RE-U1REMffi4TS FORE%MTHON FROMIO\UMU PRE4T IM"N EcUIPMIFNT V. PRODUCT/WASTE PIPING CONSTRUCTION P>PINGCONSTxUrnoN p 1 SINGLE WALL -OL2 DOVELE\\.ALL C] N OTHER 4fi0 -- - --- SYSTEM TYPE aj PREMIRE Q 2 GRAYTIY Q 3 CONA7NTI,.--,NAL SUCTION J SAFE SUCTION I?3 ctiR3-63KaM3I J5s -_..._ - rRB.LARY CUNTA waa O 1.STEEL - ®4 FIBERGLASS ❑ s.F MM3LF O Io RIGID Yf.ASfic J61 O 95 VNkNO1XN O 99 OTHER(SPe:ds;_ E] 90 NONE -_ MCONDARYCONTAR&ENT p 1 +FIBERGLASS - O 9 FLEXWX - ❑ Ho RREDPLAsnC ❑90 Nc»---._-- p o tNr N( VN O 99.011ffi4( -) PH ING'TURBINE CONTAINMENT SLIP TYPE U I SINGLE AX ALL 2 DJUBLE WALT. Q 90 NONE 414d VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRBAARY CONTAINMENT - a 1 STEEL..__-fp.4 FIBERGLASS o 10 RIGIDELASDC. a 90.NCM 0 99 OT'HER(SpeeQy, ,=1 VENT SECONDARYCONTAUIrENT O I sITEt A EMERGLAss E3 10 RIGIDPLASDC O 90 NONE 1199 OTHERSims:fy) VRPRBdARYCONTAIIu ENT p (STEEL JA _ESERGLAss p 10 Gron.Amc_ O 90 NONE O 99.OTTER(SIms:4) , VR SECONDARY CONTARQAENT O I.STEEL Q a FIBERGLASS O 10 RIGIDPL.ASTR O 90.NONE O 99 OTHER(Specify) 46N, VENTPwwGTRANSITION SVMPTYPE O IM401BWAIL W DOUBLE\\.ALL o 90 NONE RISER PRIMARY CONTAINMENT 1 SITEL ❑J.FIBERGLASS ❑ 10 RIGIDPLASDC O 90 NONE O 99.OTHMASprc* -"'; RISER SECONDARY CONTAINMENT p 1 STEEL 19 4 FIBERGLASS O 10 RIGID PLASTIC ❑ 90 NONE O 99 Onffit(Spmd): , FILL COMPONENTS INSTALLED I SPILL BUi1.-EC Ej i STREkERPLATEB.:frT(AIPRi 1TETOR JW41-WAINt.IENTaIMP VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRCTCTION TYPE ❑ 1.SINGLE WALL DI 0.BLE WALL [I_3 NO DISPENSERS Q Nt TNF Jp% _ __ - - 90-__- CONSTRUCTION MATERIAL O I.MMI. a.FIBERGLASS O 10.RIGID PLASTIC ❑99.OTBER(Specify) 4�* VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2 S.ACRIb1AL.ANOMS1 U J Ih1PRESSEDCUHRENT 6 LSOL.AnoN 44" IX. APPLICANT SIGNATURE CFRTMCATION: I certify tha this UST stem is compatible ,ith the hazardous substance stored and that the information prosided herein is true, a<cnr in faI csimAii.o,-itlegal ruirements. ro APPLICANT SIGNATURE DATE c 15 APPLICANT NAME(print) I 4-1 APPLICANT TITLE 4 11PCF UST-B Rev.(I1/"Drl)_112 www.OWocaor9\`j(4M completed