|
Jeri ' 9' 2004 . 2,09PM,, :oht Environmental 832-0152 No •24H- P ' 4.
<br /> r.
<br /> 6bi n r i 2L1r I efts:DI ��9��,_�.; � .�� �1� :FLC10F'. , .._lE 05
<br /> UM+TIF.D 11RO(r'!'.rW CONSOLIPA UD T ORA'I D& \3
<br /> TANY-S
<br /> UNDERGROUND STORAGE TANKS -- TANK PAGE I-
<br /> C�w'V p�geb por Tnglc)
<br /> TY1'P.OP ACTION ❑ I,NEW hERD4IT D 4-Ahf5`71DED P>MI[T 1,7 $,CHANGE OF MOWMATION ❑ 6.TEMPORARY ThWK CLOSURE 4io.
<br /> (Dllc,:k one item roily) ❑ 3.RE1+lEwAL PEAn•rII _ y_ ❑ 7-PERMANS-NTLY CLOSED ON SITS.
<br /> (Sptcifyream) ISpecifyrgstn) We.TANK REMOVED
<br /> 5-U 11VI- S NAME.(swrcm F f TY y 16Db. qp`1 ne:s 49)
<br /> (
<br /> LO ATION WITFILN SITE .3L.
<br /> Y = -
<br /> 11 i
<br /> '.:..:.::'," i .. .:....•.:..:". - '.. ,..'.:.�'. .. i ....:,,,.,: I
<br /> .' .....�r.;.,.,;:,.,::_x_:. .P p 11 ]eh�the Isar nan.of:the.TlS7s' eiri i�cludTh "f5lii)'�Ings�nd.]and�Ttsr3c9 NKICOMPARTMENTALIZED
<br /> � -71-1
<br /> y
<br /> } ;a
<br /> T' tga11_�tcxLl�.lig. tl�ll:,�. ,: .,•;:;;�....:,
<br /> T A� TANK IVKfvlA�rilFArTUR>?A x
<br /> �� ,33. COMPAIZ �1TALILl:D7ANK ❑Yes Nn
<br /> W 7 T 51S 7 31 ( ,�/ 1'V IXNIt/ If-Y,-=fT Wt OKC 92g'p fJT gwk a-v.%na n1.
<br /> DAIL'rNSTALLED +3s, TKINK CAPACITY IN GALLONS 4 NUMBER OF COMPARTMENTS
<br /> (YEARfifO) a77.
<br /> ADDITIONAL.DES CRI.ITTION(For foal ue only �d8
<br /> •:X�s. ,Ilr�r - _. - - - y+�7�- - cry�:q::-.�:..�•. - -:;i{. `.;,.s'.e:.y - - _
<br /> -
<br /> TANK USE 114. PFTROLEUM TYPE 444
<br /> J. /+'MOTOR VEMCLE FURL ©1a, REGULAR UNLEADED n 7. LEADED []5. IET FUEL
<br /> �,flhukf&somone NpWlew Type}
<br /> D lb. F](E-N4III1.I I}AL3:AQE.D 3�rS. tlITIS1:L ❑b. AV.)ATIaw GAS
<br /> ❑ 2.NON-FV1{LFETROLEl)M Q)o-MIDGRADE(TNLLADC•D ❑4. GASOHOL ❑99.OTHPIL.,
<br /> Q 3. CHEMICAL PRODUCT COMMO-rTWAME{frm,Rln:mdcxisM;gcii9l�lnvcntcrypngr)... -441' CAStllfi•amHSZ7douaMomria191nrc,norypage) f47.
<br /> [] 4. HAZARDOUS WASTE
<br /> (lrlcrudt>UsrdOil) - -
<br /> C] 95,UN7,No r
<br /> TYPE OF IANK (]1. SLNOLE WALL Ll3.SfN0IX WALL Nr1TH 8XTERI01t ' Q S. SIM3LE WALL WITH LNITEMNAL 8LADDHR SYSTEM 443,l
<br /> (Ci,eck0neitem only) MI:MBAANBI-INER 09S- UNKNOWN
<br /> ❑7 DOUIrr.1:WALL [14. SRrGLE WALL Gq A VAULT ❑99- G R
<br /> TAVKMAI,EFIAL-primwyLjnl I. BARESTP1:L El3-FIBEROLA55/PLASTY [35- CONCRh-TE El 95. ROWN 444,(lledc one/Fero 0nlY1 ❑2. STAINL ES STI!5E1. Q4, STEEL CLAD W/FIBERGLASS Q R. PRP COMPATIBLE ❑99.OTHER:
<br /> RUNFORCEI3 PLASTICtZP1 WIIW%.MF-'E1AN0+�
<br /> TANr(MATERtAL-s¢wndary Inn1c 1, [TARE STEEL ]. r r13ela(1LASS 1PLASTIC S. FRF COSAPI®LE W1100%XSTHANOL 95,UNKNOWN 441
<br /> (Check ow hmn only) ❑1 S-IANUSS$TUML 0 4, STEEL CLAD W/FIBERGLASS ❑P. Ii.KP i�O?+-COR]2ODAB[.F.)ACI4P,T ❑99.OTTim
<br /> RIIYFDRCfD PLAgT1C(FRP) ❑1a COATEV STEEL
<br /> 5_cohcRV E =
<br /> TANK fyT13R10R MM--Mi.RVBIdER LL*1ID CJ 9.FpOXY LINING ❑5.GLASS VNING 95.LNKNOWN •fab. DATE[YSTALLED A47-
<br /> OA COATING L]2.ALKYD LWI G ❑4.Dral_NOLIC LINING ❑6.L-NLMED r]99,0T mR ^,
<br /> (C6eelc one io01 )
<br /> OTHER CORTROSION IJ I.MANUPACTVASU CAT11ODIC ❑1 F1BM(7,LASS ItETNFORCZ0 PLASTIC 95.UN-K-Nr o" F m6, 1 DATE TNSTALLED W9_ I
<br /> 1PROTECTroN PROTECTION ❑a.IMPRESSED CUR.RKNr 0 99.OTHER 1
<br /> (TfApplicablo Q 2.S 1C1AL ANODE _ I
<br /> Si'1LT.AND OVF-REIT L YEAR rNSTA1J 1;© s1o, TYPEt d51. 0VIIRFILL PR07•ECT10,�EQl1IPXHW: YEARINSTALLED a
<br /> (Check 11(daI s�ply) ❑ I- L t 'TAiNMEN'1' ❑I.SALL 1 ❑3,FILL TIT S T OFf VALVE
<br /> ❑2.DROP TUFX _ ` Q 2.BALL FLOAT- Q a.>XpaiQT Q)
<br /> 3.STRIKER PLATE /U
<br /> 1 I� '.I�;� . - • '��!,�".Ai�iK LE;r1,:�•'D��'II'.,C�O1�T`: f:• : �1 1 � � �,�
<br /> I tioo.o'ihc;mohrt3rirl'' ro ams}sxllbeatbri+tTtctT+o't2ielucel.aericy.)..
<br /> IF SIOEX WALL TANK 1 G p �� 453 IF DOUP t Z WALL TANK OR TANK WITH 81 ADDER 45C.
<br /> (Check A that apply) (Cbcck o.,e/Mein oely)
<br /> ❑1.VISUAL(EXPOSED PORTION ONLY) ❑1.M^NUAI,TANK GAUG(NG 01TO) ❑1-VISUAL(SINGLE WALL].I VAU7_T ONLY)
<br /> 02, AUTOMATICTAIL-KGAUG(NGr(ATG) 0e.VADOSYZONA C12.CO.Niru'(..'OUSLv-i's:crcTMALMONITORING
<br /> 0 3. CONTINUOUS ATG D 7.GROUNDWATER ❑3.MANUAr-MONnORING
<br /> [14.STAT]SYIC-AL NVEN-CORY RECONCILL47ION ❑TI,TANK TEST114[
<br /> (SIR)+131ETFNTALTANKT&TItiG Q 99. OTHER
<br /> c.cLOSu�tE ORMA110N;1•P. 2hi lr''fi'C 'o n 'i rx :tical; _- s;='-.: _;: .::.:
<br /> ESTIMATED DAT19 LAST'USED(YR/MOIDAY) .' ' ESTIMATED QUANTITY Of ESTIMATED TANG!✓�MA � `� T.V KFILLED It � 'L.s •..
<br /> �LRTMATPRIAL°
<br /> Ycx ❑ 7`10
<br /> Ell l e3 -6;;= -
<br /> UPCF hwfwrc-b(1199)-ila http:llwww-rulidocs.org Rev.07./16100
<br />
|