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UNMD PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERAM APPLICATION-TANK INFORMATION (Pner-wum <br /> Ty"O'AZ0Nrrr -konv arm omly FuraUS7'doswearritnoWcompletemilythLtt�-rilonandswLiou 1.a.Ill,IK aml Lx hwow) 430. <br /> M <br /> I.NEW PERMIT [1 3.RENEWAL PERWI- 2rS.CHANrE OF INI-ORMA77ON <br /> 6.TEMPORARY UST CLOSURE [1 7.U%T PFRMANIINT CLA)SURE ON SIM [1 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 43% 1 DATE EXISTING UST DISCOVERED: 43M <br /> FACLLITY TI)f(Aggency Use 0*) 7 <br /> jL_l I I A....'] 1 1 . 111 F.7 7.-� <br /> BU4�PS NAME 'up lV&7WvrDBA-Doing Badness 4s) 3. <br /> CC <br /> HUSINEM SIM ADDRFSS crrf. <br /> Lod; <br /> TANK Mlt--3 432. TANK'MANUFACTURER 43a' TANK CONRGURATION:THIS TANK IS 434. <br /> -rr%4_S - 0 1.A STAND-ALoNE TANK cauvift we pop fm*hch <br /> --rpr 50-7 h13 Q 2.ONE INA COMPARTWNTEDUNtl' c*vq--ifthCv*iL <br /> YSTEM INSTALLED 435. TANK C C IN GA6LS 436- NUMBER OF COMPARTMENTS IN THE UNIT 437. <br /> . .......... .. <br /> .......... <br /> M 4)9. <br /> TANKUSE ,ErIzL OTOR VEMCLE FUELING E3.lb.MARINA FUELING -AVIKI*10�FUELING <br /> E3 3.CHEMICAL PRODUCT STORAGE [3 4.14AZARDOUS WASTEaW&x6t-042) 0 5.F-MIERGENCY GENEkA71101t FUEL(HSC F-I.A(Q <br /> E]-6.OTHER GENt�Furt. L3 %.UNKNOWN i?t-(rmER(spL6jf�,. <br /> TS PMOI,t;.Um-, 0 1&REGULAR UNLEADED E3 Ic,MIDGRAIDE UNLEADED .Wlb.PREMIUM UNLEADED 440. <br /> [1 3.DIESEL 0 5AFTFUM. Ej 6.AVIATION GA9 <br /> 8.laelltOLEUM BLEND FURI, [19.OTHER MMOLEUM(Sjxnify�. 440,% <br /> NON-PETROLEUM:E3 7.USED OIL Ll 10.ETHANOL <br /> [3 II.QnIHRNON-PI3TROLTMM(SWify� 440t.. <br /> .......... <br /> TYPE 1.SINGLE WALL 1?-2.DOUBLE WALL 0 95,UNKNOWN "3 <br /> PRIMARY CONTAINMENT I.STEEL [1 3.FIBERGLASS BLADDER 444, <br /> 7.STEEL+Ij��A L LINING L] 95,UNKNOWN ...Q_990TNER(Spo�)_ 4 44 s. <br /> SECONDARY CONTAINMENT 2rl.STr-.r-,L [3 3.rIBIZRQI.ASS Cl f,ErrEMOR MEMBRANIIE LINER 7.JACKETED <br /> 90.NONE 13 95.UNKNOWN 13 99.OuER vsp_ify� <br /> OVERFILL PREVENTION AUDIBLE&VISUAL ALARMS ;?IBALLFWAT ��'.FILLTU SIIUT-OFrvALVE <br /> u 4.TANK MEETS REQUIRMRE R LX.HMVfION FRQM OVERFILL EEEVENTION E -T <br /> QUIPMEN <br /> V -PROM <br /> PINNG CONSTRUCTION [3 I.,$;N(jl.r WAIJ.,X[2.DOUBLE WALL El?�OTHER 460. <br /> SYSTFM TYPE [K.PkESSURE Q 2.GRAVITY Q 3.CONVENTIONAL SUCTION SAFE SUCTION123 OCR 41& <br /> y CONTAR604T 0 4.Fl";RGLASS Cl &FLEXIBLE [3 10.RIGID PLAS71C 46C <br /> [190.NONE [3 95.UNKNOWN E3 99,OTHER_(Spodly�): 46" <br /> SECONDARY CONTAINMENT 0 04,ROMLASS E3 8.FLEXIBLE [3'10.RIGID PLASTIC 46& <br /> 090. E 0 95.UNKNOWN 0 99.OTHER(Spodfy): 46k. <br /> E CONTAINMENT SUMP TYPE E3 1.SLNGLE WALI E3 2.DQUI BLE WALL Q 90,NONE <br /> 0 <br /> __WSTRU <br /> 464e. <br /> VENT PRIMARY CONTAINMENT [3 i.STr..ri. Q-t.rIRFRGLASS [3 10,PIGID PLASTIC 0 90.NONE 0 99.OTHER(Spe4ify): 464el. <br /> 4W. <br /> VENT SECONDARY CONTAINMENT [3 I.STEEL 0AIFIBERGLASS [1 10.RIGID n.'-%-nC 0 90.NONE E3 99.01EHR(Spedfy). 4MM <br /> VR PRIMARY CONTAINMENT 1,S.TrLL Q��F'BrRGLAS`S .1.0'.RIGID PLASTIC [I 90..NONE 0 99.OT14ER(Specify): <br /> VR SRCONI)ARY CONTAINMENT DPLASTIC 0 N 99 OTHER Speci <br /> E] 1.STEEL EK.FIBERGLASS 10.RIG] 90.NO E 0 fy): 464bl. <br /> VhNTPIPIN(3 TR .IT.1()-NSU41 TYM ­­...., 1 SI,NOLE WA.L.L [3.2.ri..ougLEwALL 0 90.NONH 464o. <br /> ............... <br /> RISER PRIMARY CONTAINMENT E3 I,STEM. 0 10.RMID KASTIC [:190.NONF [3 99.Cyniot(Specify); <br /> 4641L <br /> RISER SECONDARY CONTAINMENT 0 1.STEEL UK FIBERGLASS 0 10.RIGID PLASTIC 0 90-NONE 0 99 OTHER(Spccify): 464kl. <br /> Fffl.COMPONFNTS YKSTATI.UD 0 1.SPIT.T.RUCKFr 0 3,STPIKFR PLATVROTTOM PROTECTOR 0 CCONTAINMENTSUMP <br /> .... .............................. <br /> kXT-All? <br /> CONS:fRUCTIONTYPE I.SINGLE WALL Q 2.RqUBLE WALL E3 3.NO DISPMMS 469L <br /> CONSTRUCTTON MATERIAL [3 1.STRrL [3 C FIBEROLAISS 0 10.RJOID PLASTIC 99.OTHER(Speay) WK* <br /> ................ <br /> 44& <br /> SlIM,COMPONENT PROTECTION 0 2.SACRIFICIAL ANODE(S) 0 4,IMPRESSED CURRENT 0 &ISO <br /> 7. <br /> CM-1-MC-A-11140N. I ftrfify-thikt tk& UST system is compatible with the hazardous substaum st.ored and that the inflonnation p_vee_�lfirdh is true, <br /> accuratr,and jw4�iII:Wmpliance witkftnl requirtmelkL& 470. <br /> APPLICANT SI(jNATURE DATE C) <br /> APPLICANT NAME(priM) APPLICANTTITLE 472 <br /> rad vn ME�!�p <br /> UPCF UST-11 Rtv.(12/2007)-V2 www.onidocs-erg <br /> too/ coo'd OETZO TZ:Lo gooz/tz/60 <br />