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11/19/2008 12:49 FAX. 9163712540 BZMAINT 12007 <br /> 0 <br /> UST Response Plan <br /> facility. This <br /> f <br /> Com pletj$ One UST p 0M Must be sul3tilitted with your initial UST operating Permit <br /> Response plan for each UST Ooritains. It supplements the Eri�ergancy Response Plans and <br /> Application and within 30 days of 0.11132805 in the information it follows the Unified Pro <br /> Ing of these instructiOnProgressMrdous Materials Business plan, (Note: Number <br /> Procedures in the facility's H <br /> Consolidated Farm data element numbers on the form.) <br /> p,01.TYPE OF ACTION—Check the appropriate box to indicate why this plan is being submitted. <br /> FACILITY ID NUMBER—This space is for agency use only. <br /> R02.FACILITY NAME—1311ter the complete Facility Name. <br /> R03,FACILITY SITE ADDRESS_Enter the street address wl <br /> nor*the facility is located,including building number,If applicable, <br /> Post office box numbers are not acceptable. This information must provide a means to locate the tw"Ity 80OWaPh'Wly' <br /> incorporated area in which the facility is located. <br /> R04,CITY—BMW the city Or un kept off-site,list that equipmont in sections R10 through RIS. <br /> RIO.EWPNENT—If you have spill control or clean-up equipment <br /> ifno equipment Is kept off-site,leave this section blar& off-site,list the equipment j6czion(s)sections R20 through <br /> R20.JOCATIONT_If yea have spill control or clam-up equipment kept <br /> p,25, If no equipment is kept off-site,leave this section blank. <br /> R30. AVAIL in sections R30 <br /> AVAILABILITY'—if you have spill control or clean-up equipment kept off-site,list the,equipment availability through R35. 117no equipment is kept Off-site,IcAvc this section blank.work necessary under this UST R� onse Plan must be identified, <br /> ,oast one person responsible for authorizing any wo P <br /> R40,NAME—At onsible <br /> Use sections R40 through to list the nme(s)of the respany work person(s). <br /> necessM under this UST Response Plan must be identified.TITLE—At Imt one person responsible for authorizing pmon(s). <br /> sections <br /> Use secd '50 through R53 to list tha job title($)of the responsiblethe,hazwdous substance can not be <br /> ERMTNATION—This section applies OdY nit <br /> the Presence Of where liquid level <br /> R60.INDIRECT HAZARD DET d used (e g., hydrostatic MOnitOting Of 1L tankannWar space' detennine the <br /> determined directly by the monitoring method <br /> measurements are used as the basis fir leak determination), Brie* describe the steps thM:will be taken to authorized <br /> presence or abunce of bawdous substance in the secondary Containment if monitoring 'nOicates & possible Una <br /> release, <br /> OR/OPTOX SIGNATURE— Phe owner/or Vshall sign in the OW Provided- This signature certifies that the <br /> WNEERApersto <br /> signer believes that all 111161-Mation submitted is true,accurate,and complete. <br /> R70.DATE—Enter the date to PIRO was 31900d, name of the person sigaing the plan. <br /> R71.OWNEIVOPERATOR NAME—Print of tyPe the g the plan. <br /> R71 OWNERIOPERATOR TITLE—Enter the title of the pe®signing <br /> 0003 <br /> (OW)-2/3 <br />