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UNIFIED PROGRAM CONSOLBDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 7 <br /> -_-. - - Awn Aaefca pti hsnnl <br /> Pogo N <br /> 'TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT O S.CIIANGEOF INFORMA71ON) ❑ 6. TEMPORARY SITE CLOSURE <br /> (CAscA on*Ilam Doty) <br /> ❑3.RENEWAL Pf.RMR �❑ 77�r PERMANENTLY CLOSED ON SITE(SAoaN�+son•tor Joestuss sMr) (Sp-ifychenp4 for locsru+s 9rJ)) lLT 8. TANK REMOVED 430 <br /> BUSINESS NAME(Sams as FACILITY NAME or DOA_Doing Bwfileas As1 FACILITY 10 F tP': ;;» t <br /> '_P`a 4 ' C. MA i-n6.,(+ <br /> LDCATION WITHIN SITE(Oplionog 431 <br /> 1 <br /> 1-TANK DESCRIPTION <br /> TANK IDR TANK MANUFACTURER <br /> W4A(1 GOMPARTMENTyes"comALIZED LANK Vs. ❑ No <br /> tf-yes"rAdr-te ono pa0s td faceam <br /> rpanmnt <br /> e . <br /> OATS INSTALLED(YEA O) TANK CAPACITY IN GALLONS �� NUMOLR OF COMPARTMENTS <br /> t. <br /> qq 2 oo0 3 <br /> ADDITIONAL OESCA:PTION(For local use*mA _ <br /> I..TANK CONTENTS <br /> TANK USE 412 PETROLEUM TYPE <br /> I. MOTOR VEHICLE FUEL ❑W REGULAR UNLEADED ❑ 2. LEADED ❑ S.JET FUEL <br /> It marked,comptote Pehoroum Type) ❑111-PREMIUM UNLEADED OTESEL ❑ G.AVIATION FUEL <br /> L3 2. NON-FUEL PETROLEUM A ❑1c-MIDGRADF_UNLEADEA ❑ <. GASOHOL ❑99. OTHER _ <br /> ❑ 7. CHEMICAL PRODUCT -'•'- <br /> COMMON NAME(1mRI NaeaNmra Meteriah lrnwnrorypag@) CAS F(from IratnMooa MAtonsb fmrtmory page) <br /> ❑4. HAZARDOUS WASTE(1ndudn1 <br /> Used 0101 <br /> t <br /> RI-TANK CONSTRUCTION <br /> TYPE OF TANK ❑ Y SINGLE WALL ❑ 3. SINGLE WA.tL WITH ❑ s. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Chock a"71orp a" X2. DOUOLE WALL EXTERIOR MEMORANE LINER ❑95 UNKNOAN <br /> ❑ 4. SINGLE WALL IN A VAULT <br /> Clog, O7.IER <br /> TANK MATERIAL-primary lank 1 BARE STEEL U 3 F)BERGIASS f PLASTIC ❑ 4.CONCRETE ❑OS UNHNO'NN <br /> fGl"'A a-it-only) ❑ 2. STAINLESSSTEEL Q 4, STEEL CLAD WIFIBERGLASS ❑ D. FRP COMPATIBLE W/IC0%METHANOL 099. <br /> REINFORCED PLASTIC(FAP) _- <br /> TANK MATERIAL-socondaly IAM ❑ 9, BARO STEEL ❑ 3. FIBERGIASS fPLASTIC 0 R. FRP COMPATIDLE WfIM%METHANOL ❑95. UNKNOW4 <br /> (Check oneunm onl)) ❑ 2. STAINLESSSTEEL ❑ A.STEEL CLAD WIFIOERGLASS ❑ 9. FRPNON-CORRODIBLE JACKET ,9210_THER� <br /> REINF ORf_EO PLASTIC(FRP) 010. COATED STEELnYf'IEn �QGk <br /> ❑ 5.CONCRE TF.. _ <br /> TANK INTERIOR LI141N(j V - UttUA IF INSTALLEO <br /> OR COATING ❑ 1. RUDDER LINED ❑ 3. EPDXY LINING D S.GLASS UND ® <br /> +G 95. NNOWTd413 <br /> ti <br /> ❑ 2. ALKYD LINING 4. I'71ENOL.t4 LINING vks- UNlINCO 0D7,UTt1ER _ - <br /> (CnocA (Fo_E IM use LIE0 . <br /> OTHER CORROSION ❑ T MAIA)FACTIHIEO CATI MC G 3. FIBERGLASS REINFORCED PLASTIC Lt 9.;, UNKNOWN 434 <br /> DATE 1NSTAtLEO <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 4, IMPRESSED CURRENT ®D9. OT/IF-R .- <br /> (Chock one Rem en+l'1 ❑ 2. SACRIFICIAL ANODE _ �^ _. - (For lerar um Dory) -_- <br /> SPILL AND OVERFILL .__._ YEAR INSTALLED TYPE(For f_AJ oe4 orgy) I OvERFtLL PROTECT KIN EOUIPMENT.YEAR INSTALLED t <br /> 'uhecK AR that apP(y) WK <br /> SP2l f.ONTA 11.1 __, Q9n n p(.,yq __ I �I. ALARM -_-_ ❑ 3. FLU.iUIIC SHUT OFF VALVE , <br /> 2. DROP WDF. y �SC!_'v ! C j. DA U_FLOAT .__ Cl 4. EXEMPT <br /> 1f <br /> a _PLATE <br /> Nr'TANK LEAK DETF.CTiON <br /> IF SINGLE WALL TANK(Check s0fNf appy): - IF DOUBLE WALL TANK OR TANK VJ)W BIADOE ft(Cheek-v 17cm-1 <br /> � F- _ � I <br /> ❑-y 1. VIrAIAL IEAF'OSED PORTION 01VLY) El S. MANUAL TANK GAUGING 04TG( El I. VISUAL(SIHCI.E WALL IN VAULT ONLY) <br /> L„J <br /> Z. AUTOMATIC TAN?(OAU&+ (AIGj I 0 6. YAIX)(•1;JUtll �.r. l:U;f itNUUUo 1NILlt$rrllAl MVI!(IVfNt+(a - <br /> ❑ 3. COWINUOUSAIG ❑ 7- GROUNDWATER ❑ 3. MANUALMONITONING <br /> ❑ 4, STATISTICAL INVENTORY RECONCILIATION TSIRI• ❑ 0. TAtlK TESTING <br /> OIENNIAt TANK TESTING - ❑94 OTHF-TI <br /> V.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN PLACE- <br /> ESTIMATED <br /> LACEESTIMATED DATE LAST USED"IMOfDAY) ES11MATEDDUAVITITVOF SUDSTANCE REMAINING 435 TANK rJuEO`ATHWERT MATERIAL? <br /> gmtons J ❑Yea 0 <br />