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04/28/2010 09:50 20936754 BAGLEY ENTERPRISFS PAGE 02 UNIFIED PROGRAM CONSOLIDATED FORM . UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION--TANK INFORMATION(One form per UST) TYPE OF ACTION (Check one item only. For an UST parnim nt clo-W&removal.complete only this section and Sections I,II,III.IV,and IX below) 430 Q 1.NEW PERMIT [3 3.RENEWAL PERMIT ® 5.CFIANGEOF INFORMATION 0 6.TEMPORARY UST CLOS 0 7.UST PERMANENT CLOSURE C 0 8.UST REMOVAL a3ob DATE UST PERMANENTLY CLOSE D: 430, DATE EXISTING UST DISCOVERED: . .' ,L.``FACII�iTY�Il�FORMAT�ON: FACELI'f YID#(.Agency Use OWY) - 1 BUSINES NAME(Same as FACILITY NAME or DBA-Doing Bvaiaeas As) ' i� c�0j,�' C r� Lr 'D HUs SITE ADDRESS . ) 503 r t;iT {± I doL TANIDESCRIIxCiON TAMC IO ti' 432 TAN10 MANUFACi'URER 433 TANK CoNFiGURATION:TMS TANK IS 434 K 6 P 0 zI.A STAND-ALONE �� .QNE1NALbl1PARTMTM RYSEDUNIT. 37 DATE UST'SYSTEM INSTALLED T A�1I Y IN GALLONS 436 NUMBER OF COMPARTAEENT3 IN THE UNIT a I1L(�TANK UNI10NT1P�S TANK USE la MOTOR VEHICLE FUELEri(1 ❑ Ib.MARINA FUELING D le.AVIATION FUELING 439 3.CNEMICAL"PRODUCT STORAGE ❑4.HAZARDOUS WASTE(WQft Used 00) ❑S.EM1r=NNi:Y GENERATOR FUEL um Ia42e1.5(e)t 439a ❑ 6.OTHER GENERATOR FUEL 1395.UNKNOWN 13 99.OTHER - ): 440 CONTENTS PETROLEUM: Ia.REGULAR UNLEMED D la MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 3.DIESEL ❑ 5.JET FUEL. D 6.AVIATION GAS 44os ( 8.Pl(ROt EUM BLEND FTSHL D MRPETROLEUM NON-PEFROLSUM:Q 7.USED OI 10.ETHANOL � N4MWLEUM TYPE OFTAKL !.SINGLE WALL .0 L DOUBLE WALL 95.UNKNOWN PRIMARY WWA-0449W Q 1.STEEL m 3.FIBERGLASS D 6.INTERNAL BLADDER 444s 7.STEM+INT6RNALLINING ❑9s.UNKNOWN .❑99.OTHER S 45 SECONDARY;CONTAINMENT, ❑ 1.STEEL 3.FIBERGLASS ❑6.SII'E'ERIOR MEMBRANE LINER 7.IACK6TFiD 41 90.NONE 9A UNKNOWN 99.OTIlh1t �s OVBRFFLL PttBVBNT1014 1.AUDIBLE dt v44IJALALARMS' 2.BALL FLOAT %3.FILL TUBE SHUT-OFF VALVE 4� : D 4.TANK MEETS UBIEMEN'f3 FOR EJR+1 V71ON FROM OVERFIIZ PREVENTION EQUIPMENT - �;%�A�1'E�PI�Il�TG',��U�`1ZON�•;.'.,:='.': P1P1NG CONSTRUCTION SoYGLE-WALLED 2.DOUBLFrWAt LED 99-OTHER 49 SYSTEM TYPE I.PRHSSURfi 7-MUVITY D 3.CONVENTIONALsUCTION 13 4.8AFESUCT0N OCR4M 4H PR{MARY CONTAINMENT E3 1.STEEL E 4.FIBERGLASS U S.R OB cU 10.RIGID PLASTIC M 1390.NONE ❑9S.UNKNOWN ❑99. k 46te SFCONDARYCONTAINMENP 1.STEEL 4.FIBERGLASS L FLE713 10.RRIID PLASTIC 46k Q 90.NONE ❑95.UNKNOWN ❑99.0THER ' !ERE IEE C AWMBNT S TYPE ®I SINOLE WALL U 2.DOUBLE WALL 90.NONE ::.'�tl: `sC:Q'I!ER�' '•A1�iR IR;i 'lC,L.EII«EiPYPING 4JCTIF VENT PRIMARY CONI'A01MEtiT IS 1L,STEEL U kFIBEROLASS U 10.RIGID PLASTIC Q 90 NONE Ll 99.OTHER(Spedfg) Abd 464d VENT SECONDARY CONTADMIENT Q L STEEL 13 4.FIBERGLASS 10.RIGID PLAST C 90.NONE 99.OTHER(Spxify) 46M VR PRIMARY CONTAINMENT I.STEEL E3 4.FIBERGLASS El 10 RIOIDPLASTIC ja 90.NONE 0 99.OTHER.(Specity) 4 4as1 VRSECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS ❑ 10.RIGIDPLASTIC 90.NONE 99.OTHER(Specify! 40 4604 S7ENTPIPING TRANSITION SL3MP TYPE 1.SINGLE WHIZ L DOUBLE WALL 90.NONE . 464LRISER.PRAIARY CONTAINMENT' I.STEEL 4 FIDERGLASS l0.RIGID PLASTIC 90.NONE 99.01HEA(Specify) 464 il RISER SECONDARY CONTAINMENT I.STEEL El 4. 5UGLASS E0.RIGIDPLASHC M 90.NONE E3 99.OTHER.(Specif) 464k 464k1 FBMCOMPONENTSINSTALLED w 1.SPILL BUCKET 3.STRWJR PIATBOOTTOM PROTECTOR E 4.CONTADVEETSmr- B1se COI4SLRUCTIONTYPE 1.SBtGLB WALL u 2.DOUBLE WAIL D 3.NO ERSPENSURS. D 9U NONE 4� MATERIAL1.SIIlBL 4.PBIBRtiL ASB 10 RI04>PLASTIC 99.0T"BR VUL GURSIDBION I'R�(}Z'ECTI©N:` . :.. STEEL COMPONENT PROTECTION ❑L SACRIFEKAL ANODER ❑4.IMPRESSEDCEIRREDT ❑ 6.ISOLATOM • IIS.�C,�l1�1'T SIta!*T.E3RE CBi 7�+ICATIOPt:I �tlllt UELT d eoApatlbie wd6 the ha=rdens sobeftsee st wod rmd list the toform"alm provided bavis is erre,accurats. 47D. APPLICANT 811C.16' DATE L� APPLECAKfT 471. APPLICANT _j an U UPCF UST-13-1/2 Rev.(12=7)