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FOS 3 <br /> i UNIFIED PROGRAM CONSOLIDATED FORM TANKS <br /> 1 UNDERGROUND STORAGE TANKS -TANK PAGE 1 (Mro pages per tan;q <br /> i <br /> Page <br /> 5.CHANGE OF INFORMATION) ❑ 6.TEMPORARY SITE CLOSURE <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ A.AMENDED PERMIT ❑ 7, PERMANENTLY CLOSED ON SITE <br /> (Cheek one item only) <br /> ❑3.RENEWAL PERMIT (SpeciFj reason•for lopl use Dory) (Speciy change•torlocal se only) C3 8.TANK REMOVED 430 <br /> 7 <br /> ACILITY ID A <br /> BUSINESS NAME(Sams as fACtL17Y NAME or DBA•Deng Business As) <br /> F <br /> The Record, a Division of World Companies,Inc <br /> AnoaU 5 <br /> LOCATION WITHIN SITE(0p6cnal) •31 <br /> I.TANK DESCRIPTION <br /> TANK MANUFACTURER COMPARTMENTALIZED TANK Yes No <br /> TANK 10 A If'Yee,complete one page for each compar-•rent. <br /> 3 TRUSCO <br /> NUMBER OF COMPARTMENTS <br /> DATE INSTALLED(YEAR/MO) TANK CAPACITY IN GALLONS <br /> 1989 / 11 10,000 <br /> ADDITIONAL DESCRIPTION(Farhat use only) <br /> CONTENTS <br /> TANK USE 432 P=Lj <br /> ❑ S. JET FUEL <br /> T. LEADED <br /> 1. MOTOR VEHICLE FVEL 1a REGUL ❑ 6. AVIATIONFUEL <br /> 3. DIESEL <br /> (It marked,complete Petrdleum Type) ❑tp. PREMI ❑g9. OTHER <br /> ❑ 2. NON-FUEL PETROLEUM ❑1.. MIDGR4.GASOHOL <br /> CA$A(from Hazardous Materials Inventory page <br /> ❑ 3. CHEMICAL PROOUCT COMMON NAME(tram Hazardous Materials!memory page) <br /> ❑ 4. HAZARDOUS WASTE(Includes 64741-55-5 <br /> IS <br /> UsedQQ Exxon Regular Unleaded C <br /> III.TANK CONSTRUCTION <br /> ❑ 3..SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER S7 <br /> YSTEM <br /> TYPE OF TANK ❑ 1. SINGLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> (Check one item only) 2. DOUBLE WALL '❑ 4. SINGLE WALL IN A VAULT ❑99.OTHER <br /> [:195. UNKNOWN <br /> ❑ 3. FIBERGLASS)PLASTIC ❑ 5. CONCRETE <br /> TANK MATERIAL-primary Urk ❑ 1 BARE STEEL �r�t} 1199. OTHER, <br /> 2. STAINLESS STEEL s>PL 4. STEEL CLAD WIFIBERGLA55 ❑ 6 FRP COMPATIBLE WI1004'e METHANOL <br /> (Check ons item only) REINFORCED PLASTIC(FRP) <br /> ❑ ] FIBERGLASS t PLASTIC ❑ S. FRP COMPATIBLE W/100%METHANOL <br /> ❑95. UNKNOWN <br /> TANK MATERIAL-secondary tank ❑ 1 BARE STEEL. ❑99. OTHER_ <br /> 4 STEEL CLAD WIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET <br /> (Check one item only) ❑ 2. STAINLESS STEEL REINFORCED PLASTIC(FRP) ❑to. COATED STEEL <br /> ❑ 5, CONCRETE ��zzVV DATEINSTALLED <br /> ❑ 3. EPDXY LINING LLa 5. GLASS LINING ❑95. UNKNOVW4433 <br /> TANK INTERIOR LINING ❑ 1, RUBBER LINEO ❑ 6. UNLINED ❑99. OTHER (Forloca <br /> OR COATING ❑ 2 gLKYO LINING ❑ 4. PHENOLIC LINING <br /> GATE INSTALLED <br /> (Check one item onl) 95. UNKNOWN 434 <br /> OTHER CORROSION 3. FIBERGLASS REINFORCED PLASTIC _ <br /> ❑ 1. MANUFACTURED CATHODIC ❑ []gq, OTHER_� (Forloca <br /> PROTECTION IF APPLICAB:E PROTECTION ❑ 4. IMPRESSED CURRENT <br /> (Check one item only) ❑ 2. SACRIFICIAL ANODE TYPE(Forloca)use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> YEAR INSTALLED <br /> SPILL AND OVERFILL <br /> [,�1.ALARM � /,�;a.9❑ 3. FILL TUBE SHUT OFF VALVE <br /> (Check aft that appy) 1] 1. SPILL CONTAINMENT� - ❑ 4 EXEMPT <br /> �n o(] ❑ 2. BALL FLOAT <br /> 10 2. DROP TUBE --ice-- <br /> . ❑ ]. STRIKER PLATE <br /> N.TANK LEAK DETECTION - - <br /> . IF DOUBLE WALL TANK OR TANK WITH BLADDER(CAeck ane item Dory): <br /> IF SINGLE WALL TANK(Check all that app ): ❑ 1, VISUAL(SINGLE WALL IN VAULT ONLY) <br /> C3 ❑ 5. MANUAL TANK GAUGING(MTG)1, VISUAL(EXPOSED PORTION ONLY) E I�2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ ❑ 6 VADOSE 20N 2. AUTOMATIC TANK GAUGING(ATG) ❑ 7 GROUNOZON ER ❑ 3. MANUAL MONITORING <br /> ❑ 3. CONTINUOUS AT^v <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ 8. TANK TESTING <br /> BIENNIAL TANK TESTING [3 99. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN?PLACE <br /> FILLED WITH INERT MATERIAL? <br /> ESTIMATED DATE LAST USED(YR/MOIOAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING <br /> gallons ❑Yes ❑No <br /> Former(Y SLNRcB Form <br />