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FROM : J. Schetter PHONE NO. : 5306667692 Dec. 02 2005 02:47PM P7 UNIFIED PROGRAM CONSOLIDATED FORM JExV Mtj TANKS UNDERGROUND STORAGE 'WANKS - TANK PAGE 1 (1'wo pages per tank) Page I of 2- TYPE OF ACTION 111.NEW PERMIT ❑ 4.AMENDED PERMIT ® 5.CHANOI OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430 (Chece one item only) ❑ 3.RENEWAL PERMIT -updated info roquest_` ❑ 7.PhILMANI:NTLY CLOSED ON SI'T'E (Spmifv reasolo (.Cpr,tHy iwwn) ..._ ❑ 8.TANK DEMO VED I3USINFSS NAME(Same u FACQITY NAME or DBA-D6U 13.6 as As) 3. FACILI.11Y ID: t. Arco Facility No. 00595 LOCATION WITRIN SITE(optional) 431 I.TANK DESCRIPTION (A scaled plot plan with the location of the UST systein including buildin and lafldmarks shall be submitted to the local agency.) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK 0 Yes No 434. PREMIUM XERXES If"Yas,•ccwptat one Page Tr. .h om.,partnuwa. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 43G NUNLLiE.K OF C'OMPARTNTFNTS (YEAR/MO) 437, 12/01/1984 12,000 I ADDITIONAL DESCRIPTION(Por local wsc oniy) 436 11.TANK CONTENT'S TANK USE 430. PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ❑Ia REGULAR UNLEADED ❑2. LEADED ❑S. JE-r FUEL (If checked,"mpltic Petroleum Type) ®lb. PP.EMIUM t,JNT,.EADED ❑3. DIESEL. ❑F. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑ Ic. MIDURADE UNL.F,ADED ❑4. GASOHOL ❑99,OTHER: ❑ 3. Cl IEMICAL PRODUCT COMMON NAME Mom H=.duus Materials lr=ntory page) 441 (.AS#(from tumdoas MaleaALS lnventofy Page) 442 ❑ 4. ILVARDOUS WASTE GASOLINE 8006-61-9 (inciudes Uwd Oil) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑I. SINGLE WALL 3. SINGLE WALL wmi[XTERIOR ❑5. SINGLE WALL W1TH INThRNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER Ej 95. UNKNOWN ®2. DOUBI.E WALL 4. SINGLE WALL IN A VAOL'I* C3 99. OTHER TANK MATERIAL-primary unk I. RARE STEEL 3. FIBERGLASS/PLASTIC Q 5. CONCRETE 95.UNKNOWN 444. (Check ane item only) C3 2, STAINLESS STEEL ❑4. STEEL CLAD W/FTRF.RGLASS ❑8. FRT'COMI'A1 LBLE 0 99.OTHER: REINFORCED PLASTIC PRP W/100%METHANOL TANK MATH- AL-secondary tank [3I. BARE STEM, 3. FIBERGLASS/PLASTIC 8. FRP C0MP'1'(B0i W/InAeh METFIA,NOL ❑95.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL ❑4. S11-ML CI,AJ>WRIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTtlElt REINFORCED PLASTIC..(FRP) ❑10. COATED STEEL [15. CONCRETE TANK R41MR1OR LINING I.RUBBER LINED 3.EPDXY LINING Ej S.GLASS LINING 95.UNKNOWN 446. DATE INSTALLED 447. OR COATING El2.ALKYD LINING [14.PHENOLIC LINING ®6.UNLINED ❑99.OTI'IER (Check one item of ) OTHER CORROSION n 1.MANUFAC FURED(;ATRODIC ®3.FIBERGLASS REINFORCED PLASTIC 0 95.UNKNOWN 448, DATE INSTALLED 449. PROTF("j'ION PROTECTION ❑4.IMPRESSED CURRENT ❑99,OTHER f A licnble ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 4.W TYPE, 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Cbmk all that apply) ®1.SPILL CONTAINMENT 20(4 _OPW_ 0 1.ALARM 2004 ❑3.FILL TUBE SHUT OFF VALVE ®2.DROP TUBE _2004 OPW M 2.BALL FLOAT 2004 Q 4 EXEMPT 3.STRIKER PLATE 1999 OPW IV.TANK LEAK DETECTION A description of the monitoring program shall be submitted to the local ugcttcy.) 1F SINGLE WALL.TANK 453 IF DOUBLE WALL TANK OR TANK WI-1"14 BLADDER 454. (Check all that ap)ly) (Chock one ilcfn only) [11. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL,TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2.AUTOMATIC TAMC GAUGING(ATG) ❑6.VADOSE?-ONE 0 2.CONTINUOUS INTERSTITIAL MONITORING [13.CONTIN't101JS ATC ❑7.GROIINDWATFR ❑3.MANUAL MONITORING ❑4. STATISTICAL INVPNTORY RP.CONCILIATION ❑8.TANK TESTING (SIR)+RTUNMALTANK'I'ESrINC 099. OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATh LAST USED(YR/MOfDAY) 455. ESTIMATED QUANTITY 01;SUBM ANCE;REMAINING 45o T&KK FI1.I.ED WITH INERT MATERIAL? 4r. kptlons ❑Yes ❑ No