Laserfiche WebLink
1 <br />UNIFIED PROGRAM ► ► FORM <br />TANKS <br />UN <br />► Rr }STORAGE <br />(Two Pages per tank) <br />Tti PE Or nCTION ❑ t. NEW PERMIT ❑ a. AMENDr;D PT RMrr'fT5. CHANCE OF INFORMATION <br />( n� may) ®3. RENEWAL Pi RMIT ®6.'I EMpORARY TANK CLOSURE ate, <br />- ❑ 7. PERMANF,NTLY ('],OSED ON SIT£. <br />dspeciIr r'T (Spedfyr ) ® 8. TANK REMOVF,D <br />BUSTMSSNAME (�4sFACtuTYNAMkaDRA- Doing Bob= As) 3. • FACILITY ID: <br />> t. <br />f..00ATION WITK N SITE (optimal) <br />431. <br />z. xr�b r�rorr <br />scaled.plot P •� ith:C Ta tion of, le. USX,syst'elm <br />TANK IT) # 43.>nchidinp,.buifa s ..Ir ndtnarica shall ix.submisocd to the iocst a eY <br />z TANK NUFACFURER ' 433: G'OMPAR'NT'ALIZFD'IANK Yes E] No ®34 <br />TA- <br />®S47gD3 <br />IME <br />%2f1$LC) 1rYes"ono „�«� <br />ATE INSTAI LED 435. pl P f« �' ; <br />D <br />DATE INET TANK CAPACITY IN GALLONS 436 NUMBER OF C�IvIpARTMEN'IS <br />8' Q IT 437. <br />ADDITIONAL DFSCRIPTION cForemly) <br />43L <br />I:. TAA ' Co . $ <br />TANK USL 439. PETROLEUM TYPE <br />011. MOTOR VEIICLEFUELII tdao. <br />rr a. RFGtJI_nR UNLEADED Q 2. LEADED (_j S. JSTFtlEL <br />< dwdzA -a Pwd®dh Type) J;Prb- PREMIUM UNLEADED o 3. Dm_im ❑ 6. AVIATION GAR <br />❑ 2- NON-RJEL PETROLEUM ❑ Jr. MIDGRADE UNLEADED D 4. GASOHOL <br />Q 99.OTI IF,R: _ <br />❑ 3. CHEMICALPROLiucr COMMONNAME ,myfie) CAS#(PromILxdo mw iw d+[1 4. dAZARDOUSWA�Tr. I ) 442 <br />d►Wadm Used Olt) <br />Q 95' UNKNOWN <br />T` ` • Ca]'�1STx3'C[TON <br />PE-ZEIIAL <br />F TANK ❑ 1, SINGLE WALL ❑ 3. SINGLE WALL WIII I r;XTFRIOR 5. $IIdGLE WAIL WITH MW -MAL BLADDF,R SYSTEM 443. <br />tc�t only) MEMBRANE LINER <br />❑ 95. UNKNOWN <br />B'2. DOUBLE WALL. ❑ 4. SINGLE WALL INA VAIII.T 99. OTHER_ <br />-pdmwy teak 1. BARB STE . 0 3. FIBERGLASS./ PLASTIC 5. CONCRS,•E 95. UNKNOWN a0A <br />d( kmeirrma+ly) ❑ 2. STAINLESS STEEL ❑ 4. STET, CLAD W/msERGLASS ❑ 8. FRP COMPATISIX ❑ 99. mHER; <br />REINFORCEDPLASTIG r•Rp W/100%MUTHANOL - <br />TANK MnTERiAi - Moondary L�.k ❑ 1. i3aRE STEEL w3. PIEF,RGLASS / PLASTIC ❑ 8. FRP COMPTIBLE W/1 W%Mfi7M OL ❑ 95. UNKNOWN 445. <br />(Cbxk ow item only) Q 2. STAINLESS STEEL Q 4. STEEL, CLAD W/FlUERGLASS ® 9. FRP NONdbRRODAS,.E JACKET 1199. OTHER <br />REINFORCED PLASTIC (FRP) Q IQ. COATEDSTEL <br />•rnNK INTERIOR LAdIIdG5. CONCRETE <br />OR COATING ❑ I. RI/ISBER LINED ❑ 3. EPDXY LINING ❑ AS <br />5. GLS LINING 95. UNKNOWN <br />R do ® 2. ALKYO LIMNG Q 4. PHENOLIC LINING A 6. UNLINED(Cb099 Crrt IFR 44s. DATE TNSTALLED 447. <br />UrHFR CORROSION L1 1. MANUFACTURED CATHODI(' fISERGLASS REINFORCED PLASTIC ❑ 95. UNKNOWN 448. DATE INSTALLED 4ao. <br />PROTECTION PROTECTION ❑ 4. IMPRESSED CURRENT <br />if i ❑ 2. SACRIFICIAL ANODE ❑ 99.0'rHlat <br />SPILL AND OVERFILL. YEAR INS"I ALLED 450 TYPE 451, OVFAFILL PRO•FGCTTON EQUIPMENT: YEAR TNSTAl,I,ED ase <br />(Clarck all thffi fly) A3 I. SPILL GONTAINMF.N t' oZ' <br />OrZ DROP TUBE � - ,�BAIA ALARM <br />LOAT _ . � R.3. FILL bSILUTOFF VAi.VE 2 <br />3. STRIKER PLATE _ZgVad <br />IV. TANKLEA#+r'DETEC Y-iON <br />(A descr itlon of. die moseaibr_iw, ro thelStd local ncy.), <br />IF SINGLL WAIL TANK 4s3. 1F DOUBLE WALL TANK OR TANK WITT3 BLADDER 454 <br />(Chou all dud w1y) (Cl"_ - item <br />® 1. VISUAL POSPORTION ONLY) ® 5. MANUAL TANK GAUGIN(: (MTG) 0 1. VISUAL (SING) <br />(EXED LE WAIL IN VAULT ONLY) <br />® 2. AUTOMATIC TANK GAUGING (ATG) Q 6. VADOSE ZONE 2, CONTINUOUS INTERSTITIAL MONITORING <br />❑ 3. CONTINUOUS ATG ® 7. GROUNDWs NIR ❑ S. MANUAL MONITORING <br />04, STATISTICAL INVENTORY RECONCILIATION ® 8. TANK M. TING <br />(SIR)+BIFNNIALTANK Tr, ,TING ❑ 99. OTIC <br />v. TAM CLOSM INFO ATi W'4 PERMANENT CLOSURE IN PLACE <br />ESTIMATED DATE LAST USED (YWMO/DAY) 455 ESTIMATEDI) QUANTITY OF SURS'TANCE PPMAiNING 46. TANK FILLED Wrl71 INERT MATMAL? 457. <br />SAW* ❑ Yes ❑ No <br />UPC'F bwftwr¢-b (1/99) . 1/4 wwwmaidomorx <br />9TO/ TTO*d oloz* <br />Rev. 02/16100 <br />60=t0 900Z/ZZ/90 <br />