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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> .A UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> If-A.-pea per tons) <br /> PDT;. of <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT 4. AMENDED PEAMIT ❑ S.CHANGEOF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE <br /> (ChecA one YeR!ony) <br /> �❑ 77 PERMANENTLY CCOSEO ON SITE <br /> ❑3.RENEWAL PERMR (6peaN ma Ian-Aw loem Ireo-1,1 (Sper'Oechenpw.ter beet Iran*My) V,8, TANK REMOVED 430 <br /> BUSINESS NAME(Se es FACILITY NAME of DBA•Doing Bw:n•»AM <br /> FACILITY IDA "'+ T <br /> ^Pa�i L <br /> on <br /> LOCATION WITHIN SITE(OP 0"89 431 <br /> I.TANK DESCRIPTION <br /> TANK IDA TANK MANUFACTURER COMPARTMENTALIZED TANK <br /> YeNo <br /> pVJP if-To .tAmolrKono P;106 for axK eamgaffmom <br /> DATE INS LLEO(l E1� TANK IGALLONS WUMDCR OF COMPARTMENTS <br /> ( KCPA® <br /> ADDITIONALOESCAIPTiON <br /> (For lata)Ira**AM <br /> A.TANK CONTENTS <br /> TAlN(USE 412 PETROLEUM TYPE <br /> I. MOTOR VEHICLE FUEL Cl la.REGULAR VNLEADED ❑ 7. LEAVED Cl S..IEI FUF.L <br /> Ir ma/keC,camptote Pe(mte,rm TyPo) ❑1p.PREMIUM UNLEADED DIESEL ❑ S.AVIATION FUEL <br /> ❑ 2. NON-FUEL PETRO►EI1M Cl 11 MIDGRADE UNLEADED ❑ A. GASOHOL ❑99. OTHrA <br /> ❑ 3. CHEMICAL PRODUCT -'-- <br /> COMMON NAME IJmm Naeurdw(a Meterialalnwn(ory page) CASA(Ilom/tdsamol,s Molormh frwnnTory pa0o) <br /> ❑4. HAZARDOUS WASTE FT"109MI <br /> Wed 0 <br /> GS UNKNOWN __ ------ -- ----.J <br /> IR.TANK CONSTRUCTION <br /> TYPE OF SANK ❑ 1.SINGLE WALL ❑ 3. SINGLE WALL PATH ❑ S. SINGLE WALL WITH INIEANAL BLADDER SYSTEM <br /> (CAnck Gm.RerllG" Z. OOUVLEWAIL EXTERIOR MEMORANE LINER 095. UNKNOWN <br /> ❑ 4. SINGLE WALL IN A VAULT <br /> ®99. OTHER.._. - .. ._. <br /> TANK MATERIAL_•PMIIary I wf k j DAAF STEEL 0 3 FIBERGIASS(PLASTIC ❑ S.CONCRETE ❑OS UNI(NOWN <br /> (CAecA one imm only) ❑ 2.STAINLCaS STEEL Q 4, STEEL GLAD WIFIDERGLASS ® 0.FRP COMPATIDI.F_WILCO%METHANOL ❑99.OTHER_ <br /> _.-_- <br /> AEINFORCED PLASTIC(FAP) I _ <br /> YANK MATf_Rfnl-socondary lank ❑ 1 BARI,STECL .__-. ❑ 3. F18ERGI.ASS I PLASTIC 0❑ A.FRP COMPATIOLE WIT 00%METHANOL 95. UNKNOWN <br /> (Check one dom Gnf)] ❑ 2 STAINLESS STEEL ❑ 4.STEEL CLAD WIFIOERGLASS ❑ % FRPNON-CORROOME JACKF.T JK99.OTTER� <br /> pill <br /> AEINc ORf_EO PtnSrlG{FRP} ❑in COATED STEEL - �(�-►ci;flh16i�}-I�'QGk <br /> 0 S.CONCRE rF.. _ <br /> TANK INTERIOR LINING VVA TF INSTALLED <br /> OR COATING, ❑ 1, RUDBER LINED Cl J. EFOXY LINING D S.GLASS UNR1C. ®B5. I1llt<NQWT•14J3 <br /> 1 <br /> ❑ 2. ALKYULINING C' 4, PHENOL ellmNG UTA ❑D3,OTHER - (Forlos .Ixc OnlYj <br /> (CAeck Gnc Tom orJyl _ - - _ -- <br /> DATE INSTALLED <br /> OTHER CORROSION <br /> DROTEC1rON IF APPLICABLE ❑ 1 MArX)FACTtA4E0 CATNOOIC G J. FIBERGLASS REo4FORCEO PIA3T(C ❑9.i. L/NKNOvVH 434 <br /> PROTECTION ❑ 4, (MPRESSE D CURRENT 099. Olmn <br /> (CW*ono item only) ❑ 2. SACRIFICIAL ANODE __ <br /> 6P1LL AND OVERFILL ._.._ YEAR INSTALLED TY (For roc.IT vsG GmyJ - OVERFILL PROTECT KIN EQUIPMENT.YEAR INSTALLED <br /> PE <br /> (GAfck sAlAdf apply( SPILL C.O14TAMI.ENi �,PALARM ❑ J. FOU.IUbH <br /> i:SHUT Off VALVE ' <br /> 2. DROP TUDE 4 -fCn®"�yq _..- T. DALI-FLOAT '❑ 4. EXEMPT <br /> .,Tiat,(rR PLATE <br /> Nr'TANK LEAK DETECTION <br /> IF SINGLE WALL TANK(Check eu(A*(apps): _ IF DOUBLE WAtL TANK OR TANK YATil BIADOER l•nck ono Rem onlr), <br /> A _� I <br /> Cl 1. Vr AIAL(EAPOSEO PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(urGj ❑�..,//1. VISUAL(SINGr.E WALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK OAUGtNCi(AT(,) ❑ 0 VnUUb6 DUNE ®S„?. CUareNUW;INlllTSNnnt l4L1NnWRrX, <br /> 03, CONTtNUOUSATG U 7• GROUN(ZNVATER 0 3. MANUALMONITONINV <br /> ❑ 4. STATISTICAL INVENTORY RECOt(CR.IATION ISM)• ❑ 0. TANK TESTING <br /> CIENNIAL TANK TESTING ❑99 <br /> V.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN PLACE .I <br /> ESTIMATED DATE LAST U56(YRfMOfDAY) ESTIMATEDOU.%14.%VoraIIDSTANCEREMAW1W, 435 TANK Fitt <br /> gmtonl ❑Ync 0 No <br />