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UNIFIED PROGRAM CONSOLIDATED FOOM
<br /> 6W TANKS
<br /> UNDERGROUND STORAGE TANKS -- TANK RAGE 1
<br /> (two pages per tank)
<br /> Page_of
<br /> TYPE OF ACTION ❑ 1 NEW SITE PERMIT 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION L7 6 TEMPORARYSITE CLOSURE
<br /> (Check one.tam only7 PERMANENTLY CLOSED ON SITE
<br /> ❑ 3 RENEWAL PERMIT vason-'nr local use only! ,Soe(`!fv reason-i.;r:c.rol use only) ❑ 8 TANK REMOVED 430
<br /> S NAME AME('same as FACtL–._.ITv NA'v1F•x DBA ,ic,rg 3r . 1T AF CILITy
<br /> BUswES - s
<br /> NELLA Oil Company 427 I
<br /> LOCATION WITHIN SITE lGotioran 431
<br /> Underground Storage Tanks south of building
<br /> I.TANK DESCRIPTION` (A scaled plot plan with,h�loc�tlor? of the UST system including buildings and landmarks shall be submitted torthe'lota!
<br /> agency.)
<br /> TANK lb-# 4 TANK MANUF ° C Oh1IPARTMENTALIZFp TANK ❑ 'fes ® Na 434
<br /> 42701 unknOVVr�, / 1 ;nr ete one page for e� r�mpartment
<br /> DATE INSTAL"ED( EAR/MO) f' TANK CAPACITY IN GALLONS 435 NUMBER OF COMPARTMENTTS 437 1
<br /> E I
<br /> - 'unknown ! 10000 1
<br /> A©DITIONAL DESCRIPTION(For local use only) 438
<br /> _._II.TANK CONTENTS
<br /> TANK USE '79 PETROLEUM TYPE 440
<br /> ® t MOTCR VEHICL=FUEL. Z 1a REGULAR ONL.FAI3ED n 2 ..FADED 75 JET FUE1_ ,
<br /> (If.roari.ed rnreprete Petrc,eum Typel I C lb_ PREMIUM UNLI-ADED 3 3 DIESEL O 6. AVIATION FUEL
<br /> 02 NON-FU"`I_PETROLEUM C, 1c. MIDGRADE UNI-LADED ❑4 GASOHOL Q 99 OTHER i
<br /> Q 3, CHEMICAL PRODUCT COMMON NAME from rlaz=•nous materials Inventory page! Lal CAS#(ffom Flazardo,s Ma:er als Inventory page) �?
<br /> 04 HA7ARDOUS WASTE Regular Unleaded Gasoline 87 Octane 86290-81-5
<br /> tlr U„des L:sed G1: .
<br />!ti..
<br /> p 95 UNKNOVVrJ
<br /> NI TANK CONSTRUCTIO77-7
<br /> N
<br /> TYPE CF TANK 1 SING,E WALLET-3
<br /> Q 1 {1 3 3 - LC VvALL WITH ]5 SINGLE,% I r.0 H INTERNAL SLACDER SYSTEM 443
<br /> rChe� one ren ory: EX I'ERIOR MEMBRANE LINER E195 U+KNI .^.'N
<br /> Z^ DCUBLE?.vALL 0 4 9GNI f ,HALL IN VAULT C 99 01 HER
<br /> I
<br /> �7AN'<r,,^.ATFRIAL ar:,ri': Q ` "t STEEL 1 ; FIBERGLASS i PI?,S 4: `. CCNCRE-E 9` •JNKNOWN 444
<br /> r; "c e t_,,a: ❑<
<br /> STAINLESSSTIFEt •> o .t L CLAD N PFIBERG,ASS ❑a PP ONIFATI3LE,149. J"HE-A f
<br /> r.f:.ILJ GRGED PLAS-IC;FRo, IG .,,^.tET is PdOL
<br /> s A.NK MATERIA_ ,. a ary"ant [? ' BARE STFi L 11;3. tG,ASS PLA 5 TI C GC, .„R=TE 3, aPJKNGVUN 445 I
<br /> ,Crer-+:� _ c•.h' i]2 5TAINt_ESS STFf!_ � S EEL CLAD VVFIBERGLASS �8 R ^PutPATI TLE ❑ag n-}'ER s
<br />' ( R_i JF"RCED PLASTIC iFRP) 'Wil,03c:ME W,1\1 1- '
<br /> [] C'ON,CRC-E ❑ 14.COATED STFFL
<br /> 4
<br />}
<br /> TANK:I LIN;NG :11 RU E�ELR L NED []3.EP)(-,X' L NI?.�i ]SGLASS LINING 95_•UNKNOWN 446 DATE INSTAi.LFD 4TI
<br /> OR COATING R 2 A_LKv5-LINING Q 4 r'E .h C"_IC I I'a.NG El 6 UNLINED 99 OT;'ER
<br /> e cogs,ne 1. ^r hr �.— �-
<br /> i - � � !For lo:aV use only)
<br /> GTNF.F.t„_�F.OS,ON C, , ^MANUr vT,.JPEDCATHODIC F8L?sur?:u EP;Ff`,,RCr'CiPLICT6; [ ci° J iKNOWN
<br /> PFiCTEC-Cv IF a^PLICAPLE PRC P-1,70N r! 5 WRESSED CURRENT [9 C1 t EP. _
<br /> (Chec,F ore 7-;n;yI []2 SACRIFICIAL ANODE
<br /> For local„se only)
<br /> SPILL AND hVE- FILL YEAR INSTAi.LFD ,v r a y 1� i OVFRTILL PPO T_ T Old EQUIPMENT`!EAR INSTALLED 452
<br /> ,_ P_(�n^ f:se vol�, „
<br /> LCnechal' 1 SPILL""ONTA.!NMENT
<br /> that ap-'.y'• 1998 "1cS I L I ALARM ®3 FILL-i'UBE.SHUT OFF VALVE
<br /> ®2 DROP TUBE 1998 yrs C!2 BALL F'_C).A ❑4 EXEMPT
<br /> TF 1998 Yes
<br /> S'RIKER ALAIV.TANK LEAK DETECTION A?"scn „^r:rthe m„Ito:in
<br /> l p g program shill t_su-rn Ited to the(oral agencv
<br /> IF SINGLIE WALL TANK,Chert:a+;that apnlyJ -453 IF r5—o JELL 1,"AI.1TANK OR TANK'WITH BLADDER 454
<br /> I I (Crock ,e F r^ -,yI
<br /> j 1 VISUAL EXPOSED PORTION C7NI_�'! [ 5 DnAiJUAL T{Nk.oAUGIidG{MTG) `r 1 VI I)AL S:NGLE WALL IN'v'AUI.T-ONLY;,
<br /> ❑ T 2 AU OMA'IC TANK GAUGING(A7Ci? ❑6 VADOSE 7r: :-
<br /> NE j ,�ON I.NjclUS INTERSTITIAL.1`00Nf rORING
<br /> C3 3 CONTINUOUS ATG T!73ROUNDVVATER O 3 MAW)Ai.MONITORING
<br /> 4 STATISTICAL INVENTORY RECONCILIATION ❑v TANK TEST:NG
<br /> +,S:R, 31ENNIAL'-ANKTESTING
<br /> TANK C%Os = Nr .:Rf44ATICJN f PEF2MANENT S< r4 IN PLACE
<br /> _vNK - L'_ N"n MATER w 467 t
<br /> s
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