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-UNMM-I)-PROGRA-M-C-ONSObWA-MD-FC)RM <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per USI) <br /> TYPE OF A=ON. (Check one item only. For an UST permement closure or removal,complete only this section and Sections L Z 112,IV,and fXbe-lo-) 430 <br /> C3 I.NEW Paudit ❑ 3.RENEWAL PERMIT fr5.CHANGE QF INFORMATION <br /> ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON srrt 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED. 430' DATE EX=XNG UST DISCOVERED: 430b <br /> 7-71 <br /> FA�CjLrN W#(Agency Use Only) <br /> I j <br /> N <br /> 3US]TTESS NAIME(Sam as FACILITY NAME or m3A-Doing Business As) <br /> "' ' (Q " . � V-tams <br /> BUSINESS SUE ADDRESS 103Y la <br /> i2a. <br /> ve. <br /> • <br /> TANK.11)# 45% TANK MAMWACTURBR 4-" TANK CONMGUPATION' TANK IS 4341 <br /> TAO�V I �( -ALONRTANK <br /> or) <br /> Tn STAND <br /> 2,ONE COMPARTACNTED UNIT. <br /> . <br /> a for."k wV ret in the azoic <br /> DATE USTVSTEM INSTALLED 4j" TANI; ACrrY,1,N:,GALLONS NTWBER OF CONTA.RTIENTS IN THE4" <br /> UNIT -31 <br /> 4 <br /> VTTANIL 7 <br /> Is-MQT�=VMUCLE PUB1240 E3 lb.MARINA FT ING LI I c.AVIAMNPtMLW0 43" <br /> 3.CHEMICAL PRODUCT STORAGE 0 4.HAZARDOUS WASTE(1-lud.Used OiQ 5.EMERGENCY OR1,1ERATOR FUEL MC J25281j(c)l <br /> [3 6.07HER GENERATOR FUEL L) 95.UNKNOWN ❑ 99.OTHER (Specify), -9- <br /> 419a <br /> CONTENTS PrMOLaw. El I&REGULAR UNLEADED [Ile.MIDGRADE UNLEADED lb.PREMIUM UNLEADED 441 440 <br /> ❑ 3.DIESEL ❑ S.MT FUEL ❑ 6.AVIATION OAS <br /> ❑ s.PETROLEUM BLEND FUEL Ll 9.OTHER PETROLEUM <br /> N014-PETROLEUM;Q 7.USED OIL 0 10,ETHANOL <br /> OTHER NON-PETROLEUM(Sp!. ; 4405 <br /> W-4 <br /> I,TYPE <br /> OF TANK Ll I-SINGLE WALL2- EJ DOUBLE WALL 95,UNKNOWN 443 <br /> PRIMARY CONTAINMENT 1.STEEL 41FMERGLASS El 6.INTERNAL BLADDER <br /> 7.STEEL+INTERNAL LINING [j 95.UNKNOWN 0 99.OTHER 444E <br /> SECONDARY CONTAINMENT LSTEEL 3-FMERQLASS L3 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 <br /> 90.NONE 9 95.UNKNOWN _Q 99.OTHER(Spw*) 445. <br /> OVERF11LI,PREVM4T 1.AUDIBLE&VISUAL ALARMS 0 2,BALL FLOAT 6 3-FILL TUBE ShLrr-OFF VALVE 42- <br /> ❑4 TANK MEETS REQUIREhOLNN FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> P111mr.CONSTRUCTION 01-SINULE-WALLED 2,DOUBLE-WALLED 99-OTHER460 <br /> SYSTEM TYPE 1.PRESSURE 2.GRAVITY D 3.CONVENTIONAL SUCTION M 4-SAFE SUCTION[23 CCR VdW4(3)I 458 <br /> PRDAARY CONTAINMENT 4.FIBERGLASS 8 FLEXIBLE 0 10.RIC1113 PLASTIC <br /> 1.STEEL 464 <br /> ❑ 90.NONE [1 95.UNKNOWN 99'-OTHER(Spocify). 164a <br /> SECONDARY CONTAINMENT 1.STEEL [3 4.FIBEROLASS S.FLEXIBLE C1 10AUGID PLASTIC 4141, <br /> ❑ 90.NONE El 95,UNKNOWN Lj 99.OTHER(Specify): 464a <br /> P1PJN(WrURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL Ll 2.DOUBLE WALL [j 90.NONE 464 <br /> VENT PRIMARY CONTAINMENT 1.STEEL Lj 4.FIBERGLASS 0 10.MID PLASTIC El 90.NONE Q 99.OTHER-(Spec*) 464a <br /> 464.1 <br /> VENT SECONDARY CONTAINMENT ❑ 1.STEEL 0 4.FIBEROLASS CI 10,RIGID PLASTIC 0 90,NONE 99, (Specify) "4f <br /> 464fl <br /> VR PRIMARY CONTAINMENT El 1.STESi 4,FIBPRGLASS Ll l0.RIGID PLASTIC [1 90.NONE [1 99.OTHER(Specify) 4 f <br /> 4 1 <br /> -VR S�ECONDAPY­CONTAINNIENT�O�LSTEEL [l 4.FIBERGLASS 12 10.810M PLASTIC El 90.NONE Ej 99.0tTE-R(SpeciV) 464h <br /> 46461 <br /> VENT PIPYNa-TRANsMoN suw TYPE 0 LSINGLE WALL 0 2.DOUBLE WALL 0 90.NONE 4641.. <br /> RISER PRIMARY CONTAINMENT Q 1.STEEL Ll 4.FIBEROLASS Lj 10.RIGID PLASTIC Ll 90.NONE Lj 99,OTHER(Spdb•) 46411 464J <br /> RISER SECONDARY CONTAINMENT [:1 1.STEEL n 4.FIBERGLASS Lj 10.=PLASTIC [1 90.NONE El 99 OTHER(Sped&) 464k <br /> FILL COMPONWfr3 INSTALLED 1.SPrt I BUCKET 3-STPLEKER.PLATE/BOTTOM PROTECTOR El 4.CONTAINMENT Sube 451&u <br /> CONSTRUCTWNTYPE I&I,SINGLE WALL WALL El 3.NO DISPENSERS 0 RM NONE 469* <br /> CONSTPA=ON MATEPIAL U 1.STEEL. 0 4.FIBERCIAn 10.RIGID PLASTIC Q 99.OTHER(Spo,*) 469&. <br /> STEEL COMPONENT FRO19=014 E3 2.SACR&X%ALAN0DE-(S) ❑4.NPRMED CURRENT [16-ISOLATION 449. <br /> • '-7-j?E7"PL <br /> CER77FICATI[ON-I cer"dint this UST syEwruji compatible with the hazardous substance stored and that the information provided her is Iraq accurate, <br /> and in full iftvkme wWIczij4wuIrements. I <br /> APPLICANT SIQNA DATE &(print) 470.] <br /> 72. <br /> APPLICANT 14AZM(print) 411. : <br /> t) APPLICANT TITLE M � <br /> `ter <br /> tMCF UST-B-1/2 Rev.(1212007) <br /> 800 'd 801089860ZI 'ON XVJ SS27 U COO,d Wd 65:Z0 NOV600NO/M <br />