COMPLIANCE INFO_1999-2010 - Laserfiche WebLink

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&IFIEDP ROGRAM CONS OLIDATEDFORM 0 TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page _ of _ TYPE O F ACTION I'1. NEW SITE PERMIT I'4. AMENDED PERMIT CHANGE OF INFORMATION) 16. TEMPORARY SITE CLOSURE (Check one item only) 7. PERMANENTLY CLOSED ON SITE I'3. RENEWALPERMIT (Specify reason-for local use only) (Specify change-for local use only) I'8. TANK REMOVED 430 ys BU SIN ESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID# 1 t : s LOCATION WITHIN SITE(Optional) 431 , if NK;DES RIP,TION,(IL scaled'pfotplan wdtr thelocatr+3h o(the UST system mcfuding buildings and landmarks shall besubmrtted to'the lacaf agency} TANK ID# 432 TANKMANUFACTURER' ..._.... _.__ 433 . COMPARTMENTALIZED TANK r Yes No 434 i" If AYes=complete one page for each com artment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 b ` (_0 1 ADDITIONAL DESCRIPTION(Forlocal use only) 438 pg r . IAN�ccaNrENs zx; _... ... . TANK USE 439 PETROLEUM TYPE 440 MOTOR VEHICLE FUEL REGULAR UNLEADED r 2. LEADED r S. JET FUEL (If marked complete Petroleum Type) r 1b. PREMIUM UNLEADED r 3. DIESEL T'6. AVIATION FUEL 1-2. N ON-FUEL PETROLEUM T'1c. MIDGRADE UNLEADED T'4. GASOHOL I 99. OTHER 1-3. CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventorypage) 441 CAS#(from Hazardous Materials Inventory page) 442 r 4. HAZARDOUS WASTE(Includes Used Oil) 195. UNKNOWN . ., ... ... .. . ..� E....� .,.._ ..... TYPEOF TANK r 1. SINGLE WALL I'3. SINGLE WALL WITH I' 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) DOUBLE WALL EXTERIOR MEMBRANE LINER r 95. UNKNOWN 7 1� I 4. SINGLE WALL IN A VAULT 1'99. OTHER TANK MATERIAL-primary tank r 1. BARE STEEL 7--k-FIBERGLASS/PLASTIC T'S. CONCRETE F95. UNKNOWN 444 (Check one item only) T'2. STAINLESS STEEL 1F4. STEEL CLAD W7FIBERGLASS I'8. FRP COMPATIBLE W9100%METHANOL IF 99. OTHER REINFORCED PLASTIC F TANK MATERIAL-secondary T'1. BARE STEEL FIBERGLASS I PLASTIC I'8. FRP COMPATIBLE WF 100%METHANOL r95. UNKNOWN 445 tank I'2 STAINLESS STEEL r 4. STEEL CLAD IF 9. FRP NON-CORRODIBLE JACKET I'99. OTHER (Check one item only) WIFIBERGLASS REINFORCED PLASTIC F10. COATED STEEL (FRP) 1-5. CONCRETE TANK INTERIOR LINING r'1. RUBBER LINED r 3. EPDXY LINING r GLASS LINING 1'95. UNKNOWN446 DATE INSTALLED 447 OR COATING T'2 ALKYD LINING r 4. PHENOLIC LINING UNLINED T'99. OTHER (Check one item only) (For local use only) OTHER CORROSION r 1. MANUFACTURED r 3. FIBERGLASS REINFORCED PLASTIC 1'95. UNKNOWN 448 449 DATE INSTALLED PROTEC'nON IF APPLICABLE CATHODIC I'4. IMPRESSED CURRENT 1-99. OTHER (Check one item only) PROTECTION T'2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED TYPE(For local use only)451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 450 (Check alt that apply) (� T 1, SPILL CONTAINMENT y 1. ALARM )�i_lw,_ 3. FILL TUBE SHUT OFF VALVE I r 2. DROP TUBE L� I'2. BALL FLOAT T'4. EXEMPT r 3. STRIKER PLATE '�- rcY. .:::.m ,..-� �.�h: sr;;�-ar;_.,�«.:.,'�:�.�_W, °4� :-.�.;� .:�`,�:..��>a •: z^°y ..rs, ,.�::e ��_.xg� � v.�-.. .� �" '�•�,.�_,' ,s^'�. '� �>r�. ,> .�%,i ; a IF SINGLE WALL TANK(Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only): 454 I' 1, VISUAL(EXPOSED PORTION ONLY) r 5. MANUALTANK GAUGING(MTG) I 1. VISUAL(SINGLE WALL IN VAULT ONLY) I'2. AUTOMATIC TANK GAUGING(ATG) r 6. VADOSE ZONE r 2. CONTINUOUS INTERSTITIAL MONITORING I 3. CONTINUOUS ATG I'7. GROUNDWATER I' 3. MANUAL MONITORING I 4, STATISTICAL INVENTORY RECONCILIATION(SIR)+ r B. TANKTESTING 'r ,,.,' Ua.TA,N{f CE OStJ �It�OEMA F10N fPER>VI ANENT Ct W, i.,p� ... w_� ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ATED QUANTITY OF SUBSTANCE REMAINING 4 ANK FILLED WITH INERT MATERIAL? 457 i gallons r Yes IF No