Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM - \ <br /> 1 TAN S <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 C <br /> -- (Mo pa9et rt ,No, <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ A. AMENDED PERMIT ❑ 5. CHANGEOFINFORMATION) ❑ S. TEMPORARY SITE CLOSURET. PERMANENTLY CLOSED ON SITE❑].RENEWAL PERMIT 9eriy naa0n-bebcL uu aNY) (SpecdyWwe-IwiccN va Ony? ❑ O. TANK REMOVED K <br /> BUSINESS NAME(Same a FACILITY NAME a DBA-Do'uIg BmNoa M) FACILITY ID <br /> TPo�51555 <br /> LOGATIONWITHIN Efop 431 J <br /> 1.TANK DESCRIPTION <br /> TANK 10 TANEMANUFACTUREA tiw1.RTM T�1lZEQr A�K Yea ❑ Na <br /> t«aaNpamnemDATE INSTALLED(YEAR(MO) TANONSB OFCOMPARTMENTS <br /> ADDITIONAL DESCRIPTION(fwbcM we aHyl <br /> l" <br /> II.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> 1. MOTOR VEHICLE FUEL ❑ta. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL <br /> (Il maMe4 compMh Paapleurn Type) <br /> [I 1b PREMIUMUNLEADED ]. DIESEL ❑ e. AVIATION FUEL <br /> ❑ 2. NON-FUEL PETROLEUM ❑1c MIGGRADE UNLEADED ❑ A. GASOHOL ❑99. OTHER <br /> ❑ ]. CHEMICAL PRODUCT CAS a(ham HannlOm MebdalJ Inwnbrypwe) <br /> COMMON NAME(!/0m HaLNpua MaM1Hala Inwnfprypwel _ <br /> ❑ A H 001, SWASTE(/MUCea <br /> Wb Od) <br /> 95 wtum <br /> HL TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLE WALL ❑ 0. SINGLE WALL WITH ❑ 5. S•NGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> EXTERIOR MEMBRANE LINER 0 9 UNKNOWN <br /> (CNck.dem.Wy) 1 DOUBLE WALL ❑ e SINGLE WALL IN A VAULT <br /> ❑59 OTHER <br /> TANK MATERIAL-prvnuy brae 1. BARE STEEL ❑ J. FIBERGLASS I PLASTIC ❑ 5. CONCRETE 095. UNKNOVM <br /> (Cmckpm inm only) ❑ 2. STAINLESS STEEL ❑e_ STEELCL IIB (FRP) <br /> ❑ 0. FRP COMPATIBLE WI100%METHANOL ❑99. OTHER <br /> REINFORCED <br /> TANK MATERIAL-aewnaar,lank ❑ 1 BARE STEEL 19 1 FI9ERGIASSIPLASTIC ❑ 0. FRP CCMPATIBLE WIIW%METHANOL 095. UNKNOWN <br /> (CheckoneiNm.,0K ❑ 2. STAINLESS STEEL ❑ A. STEEL CLAD WFIBERGLASS <br /> ASTIC(FRP) ❑ 9 FRP NON-CORRODIBLE JACKET [I 99. OTHER <br /> ❑10 COATED STEEL <br /> ❑ <br /> S. CONCRETE <br /> TANK INTERIOR LINING ❑ t RUBBER LINED ❑ 0. EPDXY LINING ❑ 5. GLASS LINING 095. UNKNCWNa]] DATEINSTALLED <br /> OR COATING <br /> ❑ 2. ALKYD LINING ❑ a PHENOLIC LINING ❑ B. UNLINED ❑99. OTHER jFo,WW.c,,tlW <br /> Check <br /> OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑ ]. FlBERGUSS REINFORCED PLASTIC ❑95 UNKNOVM 411 DATEINSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ e. IMPRESSED CURRENT ❑99 OTHER (Forbcal uae only) <br /> (Check orw dem any) ❑ 2. SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Folbcal uu any) OVERFILL PROTECTION EQUIPMENT,YEAR INSTALLED <br /> (ClNK,x al Nal appy) 1. SPILL CONTAINMENT 1. ALARM ]. FILL TUBE SHUT OFF VALVE <br /> 2. DROPTUBE ❑ 2. BALL FLOAT ❑ A. EXEMPT <br /> ]. STRIKER PLATE <br /> 71V.TANK LEAK DETECTION <br /> IF SINGLE WALL TANK heck aF Pala IF pOOSLE WALL TANK OR TANK VIITH BUDDER(CNet n <br /> ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTG) 1. WSUAL(SINGLE WALL IN VAULT ONLY) <br /> 2. AUTOMATIC TANK GAUGING(ATG) ❑ S. VADOSE ZONE 2. "CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ ]. CONTINUOUSATG ❑ T. GROUNDWATER ❑ ]. MANUALMONITORING <br /> ❑ a. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑ B. TANK TESTING <br /> BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION)PERMANENT CLOSURE IN PLACE <br /> ESTIWTED DATE LAST USED(YRWOrDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED 4WTH INERT MATERIAL? <br /> 9eMna ❑Yee ❑NP <br /> CUPAFORM(1/99) Forrnetly SVVRC8 Form' <br />