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04/28/2010 09:50 2093675424 BAGLEY ENTERPRISES PAGE 03 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK OPERATING.PERMIT APPLICATION-TANK INFORMATION jonefom erUS TYPE OF ACTION (Check one iian only. For an UST permanent closare or removal,complete only this section and Sections I,I[,ILL.IV,and IX below) 430 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT 10 5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE 0 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4364 DATE EXISTING UST DISCOVERED: 4306 L. FAC INI•O TI�1N : . . FACILITY ID#(Agency Use 0*) 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS ST,' ADDRESS 1 los I IL TA_NK'DES : QN..• .. TANK ID# 432 TANK MANUFACTURER 433 T�ANK CONF7GURAnom THis TANK is 434 ap1.A STAND-ALONE TANK 3gO0 o A 3 i i'f(IDS-0 P/43 } . 6S ❑2.ONE INACOMPARTMENTEDUNLT. cowaxone � inammac DATE UST SYSTEM INSTALLED 4 TANK C A51TY GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 'iII::TANIC:UANIa:CI1., NTS` TANK USE ® I s.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ le.AVIATION FUELING 439 t] 3.CHEMICAL PRODUCT STORAGE ❑4.HAZARDOUS WASTE(kdpi a LW OR) ❑5.EMERGENCY GENERATOR FUEL[FISC¢2M31 Ac)I ❑ 6.OTHER GENERATOR FUEL 95.UNKNOWN ❑99.OTHER 0% CONTENTS PETROLEUM: SI 1a REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ iti.PREMIUM UNLEADED 440 ❑3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS ❑S.PETROLEUM BLEND FUEL ❑ 9.0THER PETROLEUM 490a NON-PETROLEUM:0 7.USED OIL ® 10.ETHANOL 11.OTHER NON-PETROLEUM 440b TYPE OF TANK 1.SINGLE WALL . 2.DOUBLE WALL 95.UNKNOWN 443 PRIMARY CONT 1.STEEL. 3.FIBERGLASS 6.INTERNAL BLADDER 444. T.STEEL+INTERNAL LINING 95.UNKNOWN g 99.OTHER 444a SECONDARY CONTAINMENT ❑ 1.STEEL 3.FfBERGLASS ❑6.EXTERIOR MEMBRANE LINER 0 T.JACKETED 445 90.NONE 9S.UNKNOWN 99.(}1HER 44U OVERFILL PREVENTION L AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452. ❑4.TANK MEETS REQUIRB4ENTS FOR N FROM OVERFILL PREVENTIONE U[PMENT d _ .'.:vd.IRtiIU(l�i'/.•�F' 6T. 1' �1®:: .. PIPING CONSTRUCTION 1.SINGLE-WALLED 2.DOUBLE-WALLED Q 99:OTHER 46D SYSTEM TYPE L.PRESSURE E3 2.GRAVITY Q 3.CONVENTIONAL SUCTION 0 4.SAFE SUCTION CCR 458 PRIMARY CONTAINMENT 13 L STEEL jg 4.FIBERGLASS Q 8.FLEXIBLE Ej 10.RIGID PLAST[C 464 ❑90.NONE ❑95.UNKNOWN ❑99 1y)- SECONDARY CONTAINMENT 0 1.STEEL It 4.FIBERGLASS E3 S.FL.EMLE E3 10.RIGIDPLASTIC 464b ❑9o.NONE ❑95.UNKNOWN ❑99.0THER(Speciry): 464c PFPING/RIRBINE CONCAMMENT SUMP TYPE 1.SINGLE WALL 13 2.DOUBLE WALL 90.NONE 4444 REGOER ''( R)ANI VENT PRIMARY CONTAINMENT PQ 1.STEEL E3 4.FIBERGLASS E3 10.RIGIDPLASTIC 0 90.NONE 99.OTHER(Sped(y) 4641 VENT SECONDARY CONTAINMENT 13 1.STEEL 0 4.FIBERGLASS 13 10.RIGID PLASTIC 56 90.NONE 13 99.OTHER(Spec*) a4 VR PRIMARY CONTAD04 ENI' 1.STEEL 4.FIBERGLASS 13 10.RIGID PLASTIC 0 90.NONE 13 99.OTHER(Specify) 4649 VR SECONDARY CONTAINMENT 0 I.STEED E3 4.FWXOLASS 13 10.RIGID PLASTIC pi 90.NONE C 99.OTHER(Spm*) 464h 464hi VENT PIPING TRANSITION SUMP TYPE E 1.SINGLE WALL E3 2.DOUBLE WALL M 90.NONE 464L RISS PRIMARY CONTAINME pq 1.STEEL U 4.FIBERGLASS E3 10.RKLIDPLASTIC U 90.NONE U 99.OTHER(Spw*) 4 ii RISER SECONDARY CONTAINMENT E3 I.STEEL 4.F)BEROLASS 13 10.1UGIDPLASTIC NONE E3 99.OTHER(Specify) 4M 46M FILL COMPONENTS STALLED i,SPILL BUCKET ElSTRIKERPLATEMOTTOMPROTECTOR P14.CONTAfNMENTSUW 451" -!II.1"ERIDISPIKN9=CQN1`�4 ,. .. .; CONSTRUCTION TYPEL SINGLE WALL ❑L DOUBLE WALT. 133.NO DJSPZINSERS ®90.NONE CONSTRUCTION MATERIAL L STBEL E3r 4.FIBERGLASS 10.RIGID PLASTIC 99.OTHER STEEL COMPONENT PROTECTION ❑ L SACRIFICIAL ANODES) ❑4.IMPRESSiED CURRENT ❑6.ISOLATION EL AMICAM SIa I CER TION:I ear*flat tWs USYT srom Is compatible ttdtti the hamw&vs substame stored and*at the infa provided berein Is tree, M faH ea Ice witb t,... APPLICANT SI A DATE ® 4N 471. ". APPLICANT!„ � APPLI ,. .n• 1 UYCF UST-1131-112 Rev.(12/2007)