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10/30/2003 11:41 20946834?"'
<br /> FIFTH FLOOR PAGE 19
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<br /> UNIFIED PROGRAM CONSOLIDATED)FORM
<br /> TANKS
<br /> UNDERGROU" STORAGE TANKS-TANK PAGE l
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<br /> TYPE OF ACTION 1.NEW PERMIT ❑A.Ah MMM PERMIT ❑ S•CHANGE OF INFORMATION ❑ 6.TEMK)RARY TANK CLOSURE 430.
<br /> (taledL aae Yan aa40 ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE
<br /> (Swig'-0) (Specify Moon) ❑.8.TANK REMOVED
<br /> BUSINESSNA1,E PnCrLRYNANG - B95iner4 A5) 3 FACILICY(D: 1.
<br /> LOCATION VITIIIN SITE(Optlanal)
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<br /> TANK ID# - T6M POANUFACTURER / 1 ',;' COMPARTMENTALIZED TANK F I Ya o 434.
<br /> 1f"YK'mrtplee one vaso fQ mch emffra l-4m.
<br /> DATE iNSTA L.ED 415' TANK CAPACITY IN GALLONS 416 NUMBER OF COMPARTMENTS Q7.
<br /> (YEAR/MO) /S-vG'
<br /> ADDITIONAL DESCRIPTION Tmb-I me-W 431L
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<br /> SE 439. PETROLEUMTYPE f1Q
<br /> OTOR VEHICLE FUEL Q A.REGULARUNLEADED E3 Z LEADED ❑s.JET FUEL
<br /> ��►�wa+TYw) orlb. PREMIUM UNLEADED 0 3. DWAEL Q 6.AVIA7ION GAS
<br /> ❑ 2 NON,FUBI.PETROLEUM ❑lc-MMORADR UNLEADED ❑4. GASOHOL ❑99.OT'1171t
<br /> ❑ 3_CHEMICAL PRODUCT COMMpN NAME(9om Hmnbla Mseriah larmlaYDlr&) MI. �t Fla�doaF Mmuuw Invc,llory Pue)
<br /> ❑ 4_ HAZARDOUS WASTE
<br /> (Iwkda Ural OLD
<br /> Cl 95.UNKNOWN _ N
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<br /> �AL BLADDIMIYSTEM
<br /> TLE OFTANK I. SINGLE WALL ❑3. swou WALL wr i EXTERIOR Q s. !aNGLE WALLWfYMtNT6RN
<br /> (Cheek one iL-onty) MHMaRANE LINER ❑95.UNKNOWN
<br /> 2. DOUBLE WALL . SINGLE WALL IN.A VAULT ❑99. OTHER
<br /> TANK MATERIAL-P.onrl tsak 1. BARE STEEL 3. FI$ERGLASS/PLASTIC 5. CONCRETE, 45.UNKNOWN A".
<br /> (g5edc ont ilcm aly) ❑2. STAINLESS STEEL ❑4,R�yL PLASTIC OL
<br /> CLAD WLASS ❑8. FRP COMP Cl 99.OTHER! -
<br /> TANK MATERIAL-IW*admY tank 1. B �
<br /> ARE STEEL 3. I'1BERGLASS f PLASITC 8. FRP COMPI7HLE w/IOU%METHANOL LJ95.UNKNOWN 445.
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<br /> (Chk o1�ierm o*) El2. STAINLESS S`lEELp 4- STEEL CLAD W/FIBEROLASS L39, PRP NON-CORRODABLE JACKET ❑99.OTHER
<br /> REINFORCED PLASTIC{FRP) [110. COATED STEEL
<br /> 5.CONCRETE
<br /> TANK INTERIOR LINING ❑I.RUBBER LINED ❑3.ffiOXY LINING GLASS LINING 95.UNKNOWN 446 DATE INSTALLED u7.
<br /> OR COATING ❑2 ALKYD LINING ❑4.PHENOLIC I.T,fING .UNl INFO 1399.OTHER
<br /> Che*om item Dal
<br /> OTHER CORROSION ❑1.MANUFACTURED CATHODIC 3.FILSSRGLASS RElNFORCFp PLASTIC 95 99.OOIHROWN 44& DATE INSTALLED 449.
<br /> PROTECTION PROTECTION ❑4.IMPRESSED CURRENT
<br /> f lk*ble ❑2_SACRIFICIAL ANODE
<br /> SPILL AND OVERFILL,,/ YEAR INSTALLED 450. E 451. O 61LL PROTECTION EQUIPMENT: YEAR INSTALLED 4Sz
<br /> (Cbmk►Il tbst apply) }� -SPILL CONTAINMENT - IRIIA �❑3.FILL TUBE SHUTOFF VALVE_
<br /> 2.DROP 2TJBB (>(j 2 BALL FLOAT_❑4.��
<br /> 3-STRIKER PLATE
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<br /> IF SINGLE WALL TANK f�+� 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER~ at
<br /> (Check all that apply) (Check 0-Gun oay)
<br /> ❑I.VISUAL(EXPOSED PORTION ONLY) ❑s.MANUAL TANK GAUGIIlG(MIt3) ❑I VISUAL(SINGLE WALL w VAULT ONLY)
<br /> ❑2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE TONE j�2-CONTINUOUS INTERSTITIAL MONITORING
<br /> ❑3.CONTINUOUS ATG [17.GROUNDWATER ❑3.MANUAL MONITORING
<br /> ❑4.STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING
<br /> (SIR)r BIENNIAL TANK TESTINO ❑99,OTHER
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<br /> ESTIMATED DATE LAST USED(YRIMOMAY) 4"• ESTDAATPA QUANTITY OF SUBSTANCE ROAAD4NG' T WAIL DMT MATERIAL?
<br /> glom ❑Ya ❑No
<br /> UPCF bwfw'e-b(1199)-114 hUpWwww.anidomorg Rev.07/16/00
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