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4 UNWED PROGRAM CONSOLIDATED F .!M TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages r tank Pape _ of _ TYPE OF ACTION ❑1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE (Check one Item only) vG W/ D/00 P.,A- ❑ T. PERMANENTLY CLOSED ON SITE ❑3. RENEWAL PERMIT (Speci/),reason•/or local use only) (Specify change-for l use only) ❑ 8. TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or OBA-Dong Business As) 3 FACILITY ID a 1 F c 51 C . - Cc - evelo e LOCATION WITHIN SITE(Optlort ) 431 L TANK DESCRIPTION TANK ID p 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yes No 434 G w /Z $ C �� 'y ( f If'Yes*.complete one page for each compartriwt. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 ADDITIONAL DESCRIPTION(For local use only) 436 II,TANK CONTENTS TANK USE 439 PETROLEUM TYPE r� 440 1. MOTOR VEHICLE FUEL ID 1a. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (it marked complete Petroleum Type) R tb. PREMIUM UNLEADED 23. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑1c MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME(hom Hazardous Materials Inventory page) 441 CAS a(from Hazardous Materials Inventory page) 442 ❑ 4. HAZARDOUS WASTE(Includes Used 01) ❑95. UNKNOWN i III.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) ® 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER �I j TANK MATERIAL-primary lank ❑ t BARE STEEL 03. FIBERGLASS/PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN 4" (Check one Rem only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD ❑ 8. FRP COMPATIBLE W/100%METHANOL ❑99. OTHER I W/FIBERGLASS REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank❑ 1 BARE STEEL 3. FIBERGLASS/PLASTIC ❑ 6. FRP COMPATIBLE W/100%METHANOL ❑95. UNKNOWN 445 y (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET ❑99. OTHER REINFORCED PLASTIC(FRP) j ❑10. COATED STEEL ❑ 5. CONCRETE TANK ACOATING INTERIOR LINING 01. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING C395. UNKNOWN 446 DATE INSTALLED 447 ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 6. UNLINED ❑99. OTHER Check one item only) (For tical use only) OTHER CORROSION 1, MANUFACTURED CATHODIC ® 3. FIBERGLASS REINFORCED PLASTIC [395. UNKNOWN 446 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99. OTHER (Check one item only) ❑ 2. SACRIFICIAL ANODE (For tical use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(For tical use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ® 1. SPILL CONTAINMENT c LV k t cl,to S; ❑ 1 ALARM 3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT 0 3. STRIKER PLATE if W. TANK LEAK DETECTION IF SINGLE WALL TANK(Check all that apply): 453 j IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one Item onW: 454 ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING i ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ ❑ B. TANK TESTING BIENNIAL TANK TESTING ❑99, OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑No UPCF(1/99) Formerly SWRC8 Form 8