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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> IitM+o pages per Manx) <br /> i <br /> i <br />: <br /> page � Of <br /> t TYPE CF ACTION ' '+EW SITE PE?MIT lU s AMENDED PERMIT ❑ i. CHANGE CF-NFORMA71ONW '❑-f 5. -E.MPORARY SITE CLOSURE <br /> lCheCK One dem only) ' \ ❑ 7. PERMANENTLY CLOSED CN SITE <br /> ❑3 RENEWAL°ER!AIT Soea/v reason-•b local use onrv) SPecry cnarge- ocar use only) 1 <br /> `. 3. -ANK REMOVED 430 <br /> Asl C:UTY <br /> 3 ;NESS NAME;Same as FAC:UT!NAME or 08A- st <br /> Jong Juness O s i <br /> � <br /> )�o �cr 5f �A �i3� <br /> A TION WITHIN SITE f Pvonal) <br /> I.TANK OESCRIPTION j <br /> TANK iO X TANK MANUFACTURER <br /> COMPARTMENTALIZED TANK ❑ ves Cl No <br /> f" es'.:orn l o one oage for eam compar nrIWL <br /> DATE NSTALL (YEAR/MO) -ANK CAPACITY IN GALLONS VUNBER OF COMPARTMENTS <br /> 7 <br /> ADD TIONAf DESCRIPTION(For local use only) <br /> It.TANK CONTENTS <br /> TANK USE 332 o-_TROLEUM TYPE <br /> ❑ + MOTOR VEHICLE FUEL I ❑-.a. REGULAR UNLEADED I ❑ L '_AGED ❑ S. SET FUEL <br /> maM d,cornmete Pertoleum Type) 1 ^❑ I ❑ 3. AVIATION FUEL:b. 4EMIUM UNLEADED � J 3. DIESEL <br /> ❑ ?, NON-FUEL PETROLEUM j <br /> MIOGRAOE'UNLEADED I L� A. GASOHOL IJ 99, OTHER <br /> LJCHEMICALPRODUCT <br /> ❑ _-CMMON NAME(from Hazardous Materials inventory oegel i .:ASA(//dm riazamous Marginals Inventory page) <br /> 4 yALAR000S <br /> WASTE:includes <br /> 'sed Oil) <br /> JNKNOWN <br /> !II.TANK CONSTRUCTION <br /> TVP JF`ANK SINGLE'NALL 'J 3. SINGLE'NALL MTH ❑ 5. SINGLE WALL KITH INTERNAL 3LAOCER SYSTEM <br /> (ChecX one rtem only) ❑ _2. OOUBI�`NALL oYTE.4ICR.MEMBRANE l4NER ❑95. 'JNKNCWN <br /> ❑ i. SINGLE WALL:N A`/AUL- J 39. OTHER <br /> TANK MATERIAL-onmary lanx ❑ 3ARE STEEL IJ 3. ISERGLASS i PfLAS^C '❑ i. CCNCREc .r 35. 'UNKNOWN ' <br /> (Checx one item only) ❑ I i.AINLESS S SEL J 4. STEEL CJ.O W/F19ERGLISS ❑ 3_ =RP C_-MPATIBLE-AV00%METHANOL i 99. OTHER <br /> 7E!NFORCEO P)_AS7C.FRP) <br /> TANK.MA TcRIAI-secondary tanx ,rr, 3ARE STEEL 3. -IBERGLASS!P!-AS-,C 3. =RP COMPATIBLE-11'00%METHANOL J 35. UNKNOWN <br /> (Checx one item only) ❑ 2_ STAINLESS STEEL ❑ 4. 37 EEL CLAD W/FIBERGLASS ❑ 9. 'RP NON-CORRODIBLE.;ACKET ❑99. OTHER <br /> REINFORCED PLASTIC;FRP) :0 COATED STEEL <br /> J 5. CONCREE <br /> TANK:NTERIOR LINING ❑ ) ,RUBBER LINED LJ 3. EPDXY LINING ❑ 5. 3LASS LINING J 35. UNKNCWNAa3 OA TE INSTALLED <br /> OR..GATING ^1 <br /> ❑ 2- ALKYD LINING ❑ 4. -HENOUC LINING ❑ 3. UNLINED 7 99. OTHER <br /> 'Check one item on/v) mor local use I ED <br /> OTHER CORROSION ❑ 1. MANUFAC7UREo CATHODIC ❑ 3. .-IBERGLaSS RENFORC,=PLASTIC LJ 95. UNKNOWN 434 <br /> DATE INSTALLED <br /> PROTECTION IF APPLICABLE ?ROTECT)CN <br /> ❑ A. IMPRESSED CURRENT IJ 99. OTHER <br /> IChecx one item only) ISI C3 2. SACRIFICIAL ANODE For local use orMy) <br /> SPILL.:ND OVERFILL rEARINSTALLED ! 1'PE;ForloCW.3*wfP OVERFILL?ROTECTION EQUIPMENT.'EAR!NSTALL=D <br /> lChecx alt Char apply) ❑ ,-) <br /> � SPILL CONTAINMENT ALARM _ 3. =ILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE 'L7- 2. GALL.RGAT ❑ 3. EXEMPT <br /> '❑ 3. STRIKER PLATE <br /> ! IV. TANK LEAK DETECTION <br /> 'F SINGLE WALL TANK tCbecx all that aDOMP: :F DOUBLE WALL TANK OR TANK WITH BLADDER lChecx one dem only). <br /> 'iISUAL;EXPOSED PORTION ONLY) i ❑t 5. !AANUAL TANK GALIGNG)MTG) ❑ I. VISUAL(SINGL.E WALL,N VAULT ONLY) <br /> ❑ <br /> Z. AUTOMATIC TANK GAUGING(ATG) ❑ d. VAOOSE ZONE <br /> ❑ 2. CONTINUOUS INTERSTITIAL MONITORING , <br /> ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER i ❑ 3. MANUAL.MONITORING SII <br /> ❑ 4 STATISTICAL INVENTORY RECONCILIATION fSIR)- ❑ 3. -ANK TESTING <br /> 31ENNIAL-ANK 7ES7NG <br /> ! ❑99. OTHER _ <br /> V.TANK CLOSURE INFORMATION f PERMANENT CLOSURE IN PLACE <br /> =ST:IAATED DATE LAST USED IYR/MO/DAY) 1 ESTIMATED OUANTRY OF SUBSTANCE REMAINING 435 ANK R1 I ED WITH INERT MATERIAL? <br /> `alKxtS <br /> 'E Yes -No <br /> CURAFORM(4/99) Formerly SWRCS Folin 8 <br />