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11/01/2001 11: 27 20995193"0 VILLAGE WEST MAPTNA PAGE 06 <br /> IDZ <br /> UNIFI!D pROORAM CONSOLIDAT!D FIRM <br /> TANK <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> P.r <br /> P600 <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT CJ 1.AMENDED PERMIT ❑ S. CHANGE OF INFORMATION) ❑ tl. TEMPORARY SITE CLOSURE <br /> (Ch.c,an.N.m dMy) <br /> ❑�.RENEWAL PERMIT O 7. PERMANENTLY CLOSED ON SITE <br /> (Zr.cky r..avn•krimso u,.°^rY) (Sp-c6 o"o-Ar Iac.M u..only) © [. TANK REMOVED 430 <br /> BUSINESS NAME(Sam.a FACILITY NAME rX DM-0"EINIAses Aa) FACWTY 10 0 � <br /> LOCA ION WTMIN SITE( 4,11 <br /> c7 z;2 1 <br /> L TANK O!3CR I"ON <br /> TANK 11)0 TANK MAN COMPARTMENTALISED TANK ❑ Yu J�'N. <br /> Tit-of geos Y Y 5 It-Yes',aamW.l.un.P.,.M..ah aynp«Vn.nL <br /> A IN ALLEO(YEAWMO) TANK GP NUMBER PAq <br /> 12 5©Oa <br /> ACQTLONAL DESCR+PTION fAw1-_w uw wNy) <br /> 0.TANK CONTENTS <br /> TANK USE 437 P[TROLFUM TTP[ <br /> �. MOTOR VEMICLE FUEL Cl 1a. REGULAR UNLEADED <br /> (r/ma~conIPNl.Pavvl.um Typ.) 2. LEADED ❑ S. JET FUEL <br /> ❑111. PREMIUM UNLEADED 7. DIESEL ❑ 5. AVIATION FUEL <br /> ❑ 2. NON-FUEL RE7ROLEUM (]11. MIDWADE UNLEADED ❑ 4. GA40HOL Q 00. OTr1EA <br /> 3, CHEMICAL PRODUCT - '^ <br /> ❑ 4 HAZARDOUS WASTE(ftp Ip COMMON NAME(hvm Mu.rdou,Al.hri.la lnwnlory p.p.) GAS s(Nvm Halaldpw Altsdows lnNdory p401; <br /> Us.d 0r7 �� <br /> _ 111.TANK CONSTRUCTION <br /> Tr PE Of TANK <br /> ❑ +. SINGLE WALL ❑ 7. SINGLE WALL WITH ❑ S. SINGLE WALL NTH INTERNAL BLA DOER SYSTEM <br /> [C-h on.AIM 6.y) Br2, DDLIBLj WALL EXTERIOR MF-,MSAANE LINER <br /> ❑os. uNKNowN <br /> '13 4. SINGLE WALL IN A VAULT <br /> 1:199. OTHER <br /> TANK MATERIAL-WWO y I&M A 1 R �-y ARE STEEL 1,.J S. FIBERGLASS!PLASTIC Cl 5 CONCRETE ❑96. UNKNOWN <br /> (Cn.ck on."m oroy) ❑ 2. STAINLESS STEEL 0 4, STEEL CLAD YWFIBERGLASS 06, FRP COMPATIBLE Wl10NA METHANOL ❑N.OTHER <br /> RWNFORCED PLASTIC FRP <br /> TANK MATERIAL•A.Tanoary tall 4 SAE STEEL ❑ i, fISERGLA88 7 PLASTIC ❑ S. FRP COMPATIBLE WT100%METHANOL ❑9E. UNKNOWN <br /> (On4c;ory N.m Onry) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑ P NONLCORRODIBLE JACKET ❑00. OTHER <br /> REINFORCED PLASTIC(FRPI TEO STEEL Y E5 <br /> ❑ S. CONCRETE <br /> TANK INTERIOR LINING 131. RUBBER LINED ❑ 3. EPDXY LINING 135, GLASS LINING 0 96. UNKNOWN433 DATE INSTALLED <br /> pit COATING <br /> ❑ 2. ALKYD LINING ❑ A PHENOLIC LINING 56 0. UNLINED GOC. OTHER ' <br /> Creak am w.m GWyl <br /> Ary Fof Wed 4414 ' <br /> OTHER CORROSION ❑ 1 MANUFACTUREDGYHOtlIC ❑ ]. FIBERGU65 REINFORCED FUSTIC pS. UNKNOWN 434 DATE INSTALLED <br /> PROTECTION IF APPUCABLE MANUFACTU <br /> PROTECTION ❑ A. IMPRESSED CURRENT jK". OTHER CAMWIVEt- <br /> (Ch.c,orr w.m anryJ ❑ Z. SACRIFICIAL ANODE (Few goal ua.*no <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Far iwo)ue.ply) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Cn.cw au nur,ppyl <br /> 1. SPILL CONTrUNMEN7 -___.__. ._ ... ❑ 1.ALARM a. FILL TUBE SHUT OFF VALVE <br /> 16l Z DROP TUBE ❑ 2, BALL FLOAT <br /> ❑ 4, EXEMPT <br /> 3, STRIKER PLATE <br /> 'R �t,76 <br /> IF SINGLE WALL TANK ,N Mel• IF DOUBLE WALL TANK OR TANK HATH SLADOER am wm <br /> ❑ 1. VISUAL(EXPOSED PORTON ONLY) IQ 5- MANUAL TANK GALIOINO(MTO) 11 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(AYG) E) 5. VAOOSE ZONE <br /> $. CONTINUOUS INTRRSTITIAL MONITORING <br /> ❑ J. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ I MANUAL MONITORING <br /> CD 4 STATISTICAL INVENTORY RECONCIUATION(Slit)• ❑ A. TANK TESTING <br /> BIENNIAL TANK TESTING - CIO*. OTHER <br /> V.TANK CLOSURE INFORMATION)PERMANENT CLOSURE IN PLACE <br /> E 5TIMATED DATE LAST USED(YFJM04 AY) ESTIMATED QUANnrle OF SUBSTANCE REMAINING 436 TANK FILLED WITH INERT MATERIAL? <br /> Yet041fOM ❑N. <br /> CUPAFORM(4m) For-er[y SWRC9 FOrR1 B <br />