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UNIFIED PROGRAM CONSOLIDATED FORM <br /> -1- TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> �� (MG pages k) <br /> Page _ O <br /> TYPEOFACTION 1.NEW SITE PERMIT ❑ C AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 5. T PORARY SITE CLOSURE <br /> ([hack wro item omyl <br /> ❑].RENEWAL PERMIT ❑ T. PERMANENTLY CLOSED ON SITE � D <br /> (SperAy nepn fmr Mcal um way) (Spedy Mupe Al,lucalu»only) ❑ S. TANK REMOVED 130 <br /> BUSINESS NAME(Same•f FACILITY NAME w DOA•DW9 BwiOnS AS) FACRJTY ID 3 1 <br /> /N c, F (C /�Y2 �� 000a�W Ao5i55 <br /> L0[1a.TIO)N N1 IN SI/Tfr0,C"p"* ut 4 <br /> 1 <br /> L ,A D ::- - _ <br /> (J IvC / LCC L <br /> 1.TANK DESCRIPTION 1. <br /> TANK 103 ,a TANK MANUFACTURER COMPARTI I�GT.CLRq gK7O(�(t ❑ Yu No <br /> Lu�f•.�fY.®mphte(yNy/fe W aaM mmpanment. <br /> DATE INSTALLED(YEARIMO) TA7NK CAPACITY IN GALLONS NUAYmmOMJPARTME�IIEHEALTH <br /> OBJ 0UU 4. / CC��YYPVVI ' / 1.• V� l r <br /> ADDITIONAL DESCRIPTION(Fwbcal we aNy) _ <br /> II.TANK CONTENTS <br /> TANK USE 433 PETROLEUM TYPE <br /> t. MOTOR VEHICLE FUEL ta. REGULAR UNLEADED TO LEADED ❑ 5. JET FUEL <br /> Type) ❑10. PREMIUMUNLEADED DIESEL ❑ S. AVIATION FUEL <br /> 3. NON.FUELPETRDLEUM Ic MIDGRADE UNLEADED GASOHOL ❑99. OTHER <br /> ❑ 0. CHEMICALPRODUCT <br /> ❑ 1. IV.UR0011S WASTE(MUuasa COMMON NAME(hwn NuaNpw MaMdLa lm+Morypa9e) Cass(hom HafME0ai M4NKaH In.enmry page) <br /> UeeO Oq <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK `M❑ 1 SINGLEWALL ❑ 3. SINGLEWALLNATH ❑ S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Check pM dem aNq �I 3. DOUBLEWALL EXTERIOR MEMBRANE LINER Q95. UNKNOWN <br /> ❑ 4. SINGLE WALLIN A VAULT ❑99. OTHER <br /> TANK MATERIAL-plknary lam I BARE STEEL ❑ 3. FIBERGLASS!PLASTIC ❑ 5. CONCRETE 0 9 UNKNOYM <br /> (Check Om dem oMy) ❑ 2 STAINLESS STEEL ❑4. STEEL CUD W9FISERGLASS ❑ B. FRP COMPATIBLE Wl1W%METHANOL 0 9. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-aacpnaary lank ❑ 1 BARE STEEL 3. FIBERGLASS I PLASTIC ❑ B. FRP COMPATIBLE Val M%METHANOL 095. UNKNOWN <br /> (CMckam dem oNy) ❑ 3, STAINLESS STEEL ❑ 4. STEEL CL,kUWFIBERGLASS ❑ 9. FRP NON-CORROO18LE JACKET 099. OTHER <br /> REINFORCED PLASTIC(FRP) ❑10 COATED STEEL <br /> ❑ 5.CONCRETE <br /> TANK INTERIOR LINING ❑ I. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWM133 DATE INSTALLED <br /> OR COATING <br /> ❑ 3. ALKYD 11NING ❑ 1. PHENDLID LINING [IS. UNLINED ❑99. OTHE0. <br /> (rock aM demo ) <br /> Fprlocal u»on ) <br /> OTHER <br /> PROTECTION <br /> CORROSION IF ON ❑ 1 MANUFACTURED CATHOOIC ❑ ]. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 4]I DATE INSTALLED <br /> PROTECTION IF APPUGBLE PROTECTION <br /> ❑ L IMPRESSED CURRENT ❑99. OTHER <br /> Chock wM iNm aoW ❑ 3. SACRIFICULANODE (ForkKal uae amyl <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Fwlwlu»only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Cn aF Nu apply) 1. SPILL CONTAINMENT 1.ALARM 3. FILL TUBE SHUT OFF VALVE <br /> 19 2. DROP TUBE ❑ 3. BALL FLOAT ❑ 4. EXEMPT <br /> 3. STRIKER PLATE <br /> IV.TANK LEAK DETECTION <br /> IF SINGLE WALL TANK IIFp UBLEWALLTANKGRTANKWITN DOERCMckone g <br /> ❑ 1, VISUAL(EXPOSEO PORTON ONLY) ❑ S. MANUAL TANK GAUGING INTO) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> 3. AUTOMATIC TANK GAUGING(ATG) ❑ B. VADOSEEONE t. CONTINUOUSINTERSTITIAL MONITORING <br /> ❑ ]. CONTINUOUSATG ❑ T. GROUNDWATER ❑ 3. MANUALMONITORING <br /> ❑ 4. STAT)STCALINVENTORY RECONCILIATION(SIR)• ❑ e. TANKTESTING <br /> BIENNIAL TANK TESTING 09e OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE UST USED(YRIMCIDAY) ESTIMATED DUANTRY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? <br /> (� 9ewn. ❑Yu ON. <br /> � o�las�oi <br /> CUPAFORM(4/99) Formedy SVJRCS Fomt 8 <br />