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z09 � ! 3 <br /> tJ1" FMD PROGRAM CONSOLIDATED FOIA I <br /> TANKS K P (a D <br /> UNDERGROUND STORAGE TANKS - TAN if <br /> h <br /> (Two pages per tank) <br /> Page_of <br /> 4.AVfEWED PERMIT ❑ 5.CHANGE OF LV- ION ❑ 6.TEMPORARY TANK CLOSURE 430. <br /> TYPE OF ACTION NEW PERMIT ❑ ❑ 7•PERMANENTLY CLOSED ON SITE <br /> (Check one item only) ❑ 3.RENEWAL PERMIT ❑ g•TANK REMOVED <br /> (Specify reason) (Specify reason) 1. <br /> BUS NAME(Sm as FACnJTY NAME or DBA-Doing Busineu AS) <br /> S�INES3. FACILITY ID: <br /> �/ J lG°G�IBN 431. <br /> LOCATION W IN SITE(Optional) <br /> I.TANK DESCRIP'T'ION <br /> a144,plot plan with the location of the UST system including buildings and 3andmarks�sl1 bMe submitted to the ENTALIZED TANK agency.) <br /> No 434. <br /> ANK ID# 43= TANK MANUFAC�RER <br /> I �f // , I If"Yes.'complete one page for each rnmyanment. <br /> DATEINSTALLED <br /> / a3s. TANK CAPACITY IN GALLONS 436. ,-U,1��ER OF COMPARTMENTS 437. <br /> R�Mt� �r ©L 439. <br /> ADDITIONAL DESCRIPTION(For local use only) <br /> II.TANK CONTENTS <br /> 44o. <br /> TANK USE439. PETROLEUM TYPE <br /> ❑ 1. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑2. LEADED ❑5. Jam] FUEL <br /> (1f decked complete Peaokvm T}ye) ❑lb. PREMIUM UNLEADED ❑3.,DIESEL ❑ <br /> 6- AV'LkTION GAS <br /> [3 2. NON-FUEL PETROLEUM ❑lc. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: <br /> a42 <br /> ❑ 3. CHE.VIICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) <br /> as 1. CAS#(from Hazardous Materials Inventory page) <br /> ❑ 4. HAZARDOUS WASTE <br /> (includes Used Oil) <br /> 495.UNKN01i'v <br /> III.TANK CONSTRUCTION <br /> SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5- SD�GLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> sone <br /> TANK MEMBRANE LINER ❑95• UNY-NOWN <br /> e item only) 4. SINGLE W ALL IN A VAULT ❑99. OTHER <br /> ❑2. DOUBLE W ALL ❑ 444 <br /> ATERIAL-prvmry tank BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑�• CONCRETE ❑95.UNKNOWN <br /> aemonly) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑S- FRP COMPATIBLE ❑99.OTHER: <br /> REINFORCED PLASTIC w'!t00'/>METHANOL <br /> 445. <br /> ATERIAL-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑S. FRP COMPTIBLE W/100%METHANOL 95.UNKNOWN <br /> _ 99.OTHER <br /> ne item only) ❑2. STAINLESS STEEL❑4• REINFORCEDLC PLASTIC(FRP) ❑10 RPN <br /> COATED O ODABLE JACKET <br /> ❑5. CONCRETE 446. DATE INSTALLED 447. <br /> TERIOR LI ❑LRUBBERLINED ❑3.EPDXY LINING ❑5.GLASS LINL`G ❑95.99.OTHERWN <br /> TING ❑2.ALKYD LINING ❑4•PHENOLIC LINING l�•UNI-DrED ❑ne item only) 5.UNKNOWN nag. DATE INSTALLED aa9- <br /> OTHER CORROSION I.MANUFACTURED CATHODIC ❑4. ED REINF ITCH PLASTIC ❑99.OTHER <br /> PROTECTION PROTECTION <br /> f Applicable) ❑2.SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEAR 452- <br /> 'STA ED aso. TYPE ast. Q1 PROTECTION EQUIPMENT:❑ FILL <br /> ,LUBE SHUT O F VALVE <br /> (Check all that apply) O 1.SPILL DROP CONTAINMENT /C ❑ BALI-FLOAT_ ❑4•EXEMPT <br /> TUBE <br /> ❑3.STRIICER PLATE <br /> IV.TANK LEAK DETECTION <br /> (A description of the monitoring program shall be sub33- IF DOUBLE WALL TANK OR TANK WItted to the local agency.) TH BLADDER 454 <br /> IF SINGLE WALL TANK (Check one item only) <br /> (Check all that apply) 5.MANUAL TANK GAUGING(MTG) ❑ 1.'ISUAI=(SINGLE WALL IN VAULT ONLY) <br /> ❑ 1. VISUAL(EXPOSED PORTION ON ❑ <br /> ❑2. AUTOMATIC TANK GAUGING(ATG) [3 6.VADOSE ZONE ❑2-CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3. CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MANUAL MONITORING <br /> ❑4. STATISTICAL D,VEA'TORY RECONCILIATION ❑g•TANK TESTING <br /> (SIR)+BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE S57 <br /> 435. ESTIMATED QUANTITY OF SUBSTANCE RENIAr"D ash. TANK FILLED WITH INERT MATERIAL? <br /> ESTIMATED 4TE LAST USED(YRMO/DAY) F-STTM ❑Yes ❑ No <br /> ` -� gallons <br /> I)PCF hwfwrc-b(1/99)-1/4 <br /> http://www.unidocs.org /� Rev.07J16/00 <br />