BILLING - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) TYPEOFACTION Ell.NEW SITE PERMIT ❑ 4. AMENDED PERMIT IAS. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE (Chackoneihmonly) ❑ 7. PERMANENTLY CLOSED ON SITE ❑3.RENEWAL PERMIT (Spedry reason-rorbcaly»Dory) (Specify change-rorlool use onM ❑ B. TANK REMOVED 430 D BUSINESS NAME(Stare as FACILITY NAME or DBA-Doirp Business As) FACILITY IDR ry 1 CNe t- A•IC+C) R� a.i r :f LOCATION WITHIN SITE(Opeo.Q 431 - e c_ q�.-k D, 5 S /LUn 1.TANK DESCRIPTION TANK IDs I TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yes No It'Yan',rsmplare one page for each c.m adm nl. DATE INSTALLED(YEARIMO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS ADDITIONAL DESCRIPTION(F.rlscal use ony) 11.TANK CONTENTS TANK USE 632 PETROLEUM TYPE (11. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED LEADED 135. JET FUEL deo,comph.Petmhum Type) ❑lb PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑1c MIDGRADE UNLEADED ❑ 4. GASOHOL 1199 OTHER ❑ 3. CHEMICAL PRODUCT CAB 9@om Razalloua stated.).lm+anrorypage) ❑ 4. HAZARDOUS WASTE(Includes COMMON NAME(/mm HanNom Marshals lnronforypage) Laski Oho 95 UNKNOM III.TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one item ony) ❑ 2. DOUBLE WALL E%TERIOR MEMBRANE LINER ❑95. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT ❑H9 OTHER TANK MATERIAL-ptlment unk lj BARE STEEL ❑ 1 FIBERGLASS I PLASTIC ❑ 5. CONCRETE 1195. UNKNOWN (Check..Bemonyl ❑ 2. STAINLESS STEEL ❑4. STEEL CLAD WIFIBERGLASS ❑ 8. FRP COMPATIBLE W/100%METHANOL 099. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-a...dary tons X1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 8. FRP COMPATIBLE WI100%METHANOL 1195. UNKNOWN (Check one ilsm orW ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFISERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET 1199. OTHER REINFORCED PLASTIC(FRP) 010. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOM433 DATE INSTALLED Oft COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING UNLINED 1189. OTHER (Check o.Ilam only) (Forlocal use onl) OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC C13. FIBERGLASS REINFORCED PLASTIC 5. UNKNOWN 434 DATEINSTALLED PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99. OTHER (Check one item Dory) ❑ 2. SACRIFICIAL ANODE (Forbcel use ony) SPILL AND OVERFILL •a YEAR INSTALLED TYPE(Forl.ca/uae Dory) OVERFILL PROTECTION EQUIPMENTS YEAR INSTALLED (Check M that apply) 111 SPALL CONTAINMENT ❑ 1. ALARM ❑ 1 FILL TUBE SHUT OFF VALVE ❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE W.TANK LEAK DETECTION IF SINGLE WALL TANK(Check all that ap ): IF DOUBLE WALL TANK OR TANK WITH BLADDERCheck one item only): ❑ 1, VISUAL(E)POSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 8. VADOSEZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUSATGI❑I'''II L GROUNDWATER ❑ 3. MANUAL MONITORING 114. STATISTICAL INVENTORY RECONCILIATION(SIR)t �y 8. TANK TESTING BIENNIAL TANK TESTING 99. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE UST USED(YWMO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLEOWITH INERT MATERIAL? sellers ❑Yes IkN. CUPAFORM(4/99) • • Formerly S1ARC8 Form B C�5 03/a)