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IED PROD CONSOLIDATED FORM <br />UNDERTANKS <br />GR ST ' TAN - T PACrE 1 <br />M mm. Will (-o >ag- lir tank) <br />TY OF ACTON ❑ 1,NEWPERMLT Pagc-of- <br />❑ 4• AMENDED PERMIT S. CHANGE OF INFORMATION ❑ 6. TampoRAp TANK CLOSURE 430. <br />(aaat.itca„mty) ❑ 3.RENBWALPERMIT <br />❑ 7. PF•RMANENTLY CLMED ON S1TF <br />(spea(yimom) (Spmry8. TANKREMOVF.D <br />Bus ESS NAME (sxw.; FAcn m NAW utDIIA - nw As) 3. I'"ACILITY ID: <br />� H'S �EQoo3yz E. <br />LOCA J'ON wt aalld SITE (ow) A ` may( �} d <br />u�M LG✓!2..�. �.e d ( GC_ <br />E.I: 17, A1Y.14' D..... <br />(4L:scaled.;p7pt.planwittlfie.location•OLtate;UST' stem•inchidiogbuildings.woII aSbAubeSubmittedtothe•kxat' .epcy <br />TANK ID # tea• TANK MANE)FACTURF,R 4aa. )' <br />FA G5 y -� O2 �U SC-0 <br />COMPARTMEIyT Jc, em � TANK YCS ❑ Np <br />v C/ 1f w�: Acte wm Pic fa a� mmemt. <br />DATE INSTALLS,) 455. TANK CAPACITY IN GALLONS 454. NUMBER OF CUMI'ARTMF.NTS <br />`3 !1)-- � $ `r �n c� 437ADDII7ONIAL DLZ ITON (For lawl,��y) <br />438. <br />'LL-T <br />ANkcONTivTs <br />TANK USE 439. PEs-1 ROLF,UM TYPE <br />Of, 1. MOTOR VEHICLE FUEL440 <br />�ia. REGUa.AR UNLEADEA O 2. LEADED p s. JET FUEL <br />OTchodmd. c*mp%%Paff kmTypa) ❑ lb. PREMIUM UNLEADED 03. DIESEL ❑ 6. AVIATION GAS <br />❑ 2. NON-FUEL PETROLhUM ❑ Ie: MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. O'er: <br />❑ 3. (1113MHAZA CAL DOUSW STE COMMONNAMF, (fa,mlb=d" mmiaklov�mwy�,) ae,. CAS# rrom, <br />❑ 4. HAZARDOUS WASTE [ U+�btY pmt) 442. <br />(u,a iasedtAr) <br />❑ 95. UNKNOWN <br />III TA1'Z ONS RiUC7't N <br />TYPE OF TANK ❑ 1. SINGLE WALL 0 3, SINGLE WALL WITH ExTFK10R Q <br />(Cheek one item only) MEMBRANE LINER 4 5. S1Nc:l.t WALL. WL WL I h INTERNAL BLADDER SYSTEM M3. <br />2, DOUBLE WALL ❑ 4. SINGLE WALL, IN A VAULT <br />095 ' UNKNOWN <br />TANK MATERIAL _ ❑ 99. O?t1ER <br />pnas4yt�,k ❑ I. BARL• STffi. 3. FIB7=R(it.nSSIPLAST[f.: ❑ 5. CONCRETE Q 95. UNKNOWN 444 <br />( �a iia, may) ❑ 2. STAINLESS STEEL ❑ 4, STEEL CI; AD W/F79ERGi.ASS ❑ 8. FRP COMPATIBLE ❑ 99. OTHER: <br />REINFORCED PLASTIC W/100%MFTHANOL - <br />TANKMAT17tIAL- E]1. BARESTEFI: 3. FIDERGLASS/PLASTIC $. FRPCOMMULL W/1uV%METHANOL95. UNKNOWN 445. <br />( One iw may) ❑ 2. STAINLESS STEEL 4. STEEL CLAD W/PMERGLASS ❑ 9. FRP NON-CORRODABLE JA(,TET Q 99. OTHER <br />RF,INFORCED PLASTIC (FRp) ❑ 10. COATED STEEL <br />❑ 5. CONCRETE <br />TANK INTERIOR LINING I. RUBBER LINA EF3. EPDXY LINING S. GLASSLtN[NG KV <br />95. UNOWN 446. DATE INSTALLED 447. <br />OR COATING ❑ 2. ALKYD LMNC. ® 4. PHENOLIC UNINO 6. UNLINED ❑ 99. OTHER <br />Chwk one b=ten <br />O.1T3ER CORROSION 1. MANUFAMURUD CATHODIC LJW FIBERGLASS REINFORCED PLASTIC E395. UNKNOWN 448. DATE INSTALLW 449. <br />PROTECITON PR0119CTTON MVRESSED CURRENT <br />Ecabtc ❑ 2. SACRIFICIAL ANODE ❑ 99.OTHER _ <br />SP1I.L AND OVERFILL YEAR INSTALLED 450. TYPE 451. OV£RFII.L PRO1 ECTION ' tJIPMENT: YEAR WS PAI.I.Fp 432 <br />(Cheek all that Why) �. SPILL CONTAINMhM1 NT e� <br />2. 'DROP TUBE � a�^% 1. <br />ALL FLOAT � jf EIEC TUgE S1tUT OFF VALVE .fid <br />STRIKER PLATE f - _ D 4. FXEMP7• - <br />IV. T LEAK DE'T'ECTION <br />:(A descsi '= ofthe monitoring 22gM shall be Lod to the local c' <br />y-) <br />IF SINGLE WALL TANK 453, IF D UB1,F., WALL TANK OR TANK WITH BLADDER 454. <br />(Check all tb t apply) (Chock tam: item only) <br />❑ 1. VISUAL (EXPOSED PORTION ONLY) ❑ 5. MANUAL. TANK GAVGlNG (MIG) ❑ 1. VISUAL (SINGLE WALL IN VAULT ONLY) <br />❑ 2_ AUTOMATIC TANK GAUGING (ATG) ® 6. VAi)OSEZONE MW. CONTINUOUS IMMYSTITIAL MONITORING <br />[13. CONTINUOUS ATG ❑ 7. GROUNDWATER <br />Q 3. MANUAL MONITORING <br />❑ 4, STATISTICAL INVENTORY RECONCILIATION ❑ S. TANK TESTM <br />(SIR) +BIENNNIAI, TANK TESTING E399- OTI luR <br />r CLOS ';' ' 141a : ToN <br />p. -;R ENT CLAMURE MPLA£E <br />ESTIMATED DATE LAST USED (YRtMO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 4�' TANK FILLED WITH INERT MATERIAL? 457.' <br />-X10215 ❑ Yes O No <br />UPCF hwfwm b (1j'99) - 1/4 www. - rg Rev. 02/I6AIp <br />810/ £TO'd OOOZ# OT:tO 90OZ/ZZ/80 <br />