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Jan 22 03 06: 45p Ro Robertson 20972-3176 p. 4
<br /> U11141YH03 11:22 209 3:l FIFTH FLOOR PAGE 08
<br /> UNIFIED PROGRAM CONSOLIDATED FORM
<br /> 'PINK: irA0251903
<br /> UNDERGROUND STORAGE TANKS-TANK A ' �/Ml ) � FAC�, a FRao�+>:3
<br /> (two p>.�-aa I7er calk)
<br /> TYPE DF ACTION � I Ngw SITE PERMIT 4 AM'
<br /> (clda w1,jft nur) d hNDi;O reRMR S CHANGE OF INFORNIA TION ❑d TEMPORARY SITE CLOSI IRV PaFc6af7
<br /> .�...<,<�rkxy i'"' " '° s ❑7 Pb RxnNEN'rLY LZO,�FOON`ITE
<br /> 1 RENEWAL PS7(M1T � :�,�y�yJ;V .�j''.E9psf '-' _
<br /> - ^• o'T.�a.�.w:1 Gra„r^T []fi TANK REMOVED dic
<br /> 15USrNESS NAMF.rS,—a:FACILITY VAMC w DSA-D..%rs.il .a.1 FACILITY ID;
<br /> NORM'S 76* FA0000483 PR0232519
<br /> L(7(:A ON (11N S1TF.IonGm1U 60t v v7elb 1tD A,Loaf .
<br /> n�
<br /> PHONE
<br /> I TANK Dt.4c l T10 jA-oidyloi pta.r w.lt7 Ux locatrne of IjfR UST sytlrm irGhllltng DURUiggs aR w .L t>,GRtI be eul7moead to the 1poy(p;anty.y
<br /> TANK luR Tank 2 3 L,2 ANK n7ANUFACTURER '77 MP ENTALILED TANK TA0251903 �Yts ❑No '
<br /> QATL•lNSTALIFD YLAK'Iviv II'Tn.rt.olrvaMMrLh�.,u4-mmmt
<br /> ( ) ,,, FANK CAPACITY)N GALL0NS <te NiJMBF.(t VF COMAARTMEN15 ..,_ 41)
<br /> ADDI2,000
<br /> TI NALDESCRIwtIUN(rww.a,n<mly)
<br /> •31
<br /> _ I1,TAN)(COAT NTS
<br /> TAVKUSE ao'P UM TYPE
<br /> ® I,MO'rORvrilICLEFURL• ® It REGULAR UNLEADED ❑tLEADED ❑
<br /> ~�
<br /> (ti,ent<.,MwPI(Ia D<daLwTyp.) S.IL•;I•UEL
<br /> I l,.PASMIUM U NLRADED ❑a.Dlt;et LD(..AVIATION FL'L•L
<br /> ❑7 NO4i.FUEL TUM ❑ I❑ i<,MIDGXADE UNLEADF,D El d.GASOHOL [_j
<br /> E2 3.CritMICAL MI•RODUODUCr f j 9?.QTH$R
<br /> COMMON NAME
<br /> (nn�n•I�.,dw»Mak.lolcllwela,YP�Io1 aAf ,ASIf(rtandaT• 1n.,..:.r.rn,•adwyP71CC) x,12
<br /> ❑ RA2AR000S wAS 11
<br /> (I wT,Aca U:ed L4I)
<br /> ❑ 9S.LTJIWOWN
<br /> 111.TANK CONSTRUG 7no.
<br /> 7YPEOVI'ANK ❑ I SINOLtwkk4 ❑3.SINOL°WALL WITH ❑F SrYCI,F,WALL WTIHINTERNAL 8LAp1)ER SYSTEM 101
<br /> (Peek am iamonlyl LX I61UOR MkN.RRANC L1NAR �..1 is L7N,SNOWN
<br /> ®2.DOUDLC WALL Q 4.BENGLE W AIJ_N VAULT 90.OT)(EA
<br /> TANK MATErIAL-Prnairy Imic ❑ 1•RARB STEFL FJUhKCiLASs I PLASTIC ❑S.CDNt•RF7p n 95.LTYKNOwN 4"
<br /> KFvAD�<,Imu,+MI ❑1.
<br /> STAIN LFSSST6ct �(R'IULCLAD W,FIfl@RGLA.S.S [)s.rap cDwnrt4LsW!I00%METk"ni,
<br /> REINFOkCED rLA5TIC(Fkr) G q9.OTr(ER
<br /> TANK NIATFRIAL• I.RARF.CTrrL IJ 3.17101irG ASS IPLASTIC ❑S.CO• nye ❑PS.UNKNOWN w
<br /> (;:Ne4m iomomyl ❑7 STAIN1.89S.A'rFEL GrA.STEEL CLAD W/F(llMCLAC,,, Q R.I"COMPTIBLLWH00e..4ETkIANOL
<br /> RTrVFORC6DPLAST)C(FRP) ❑ 10.COATED STEEL ❑9o.OSIIER
<br /> CJ 5.CONCRFT.E
<br /> TANK IN MUMLINNU ❑ I RIIRRIRLINFD 1.LDOxyL1NING (77
<br /> OACOATNC ❑ ❑S.GLASS LrN1NG ❑95.UN7(NDWN a4 DATE MSTAt•LeO
<br /> (C7rtakocclfedonly) 2ALKYD LNNO ©4PNENOI.IC,'1,NNG 5UNLNFD ❑99.OTI(ilt
<br /> OTIIERCORROSION (] ENANUFACrt:RINDCAr)roDIc _ --
<br /> Irn)o<al dreonly)
<br /> PROTECTION IF APPLICA5L1 Prtoacilov ❑I FIeLRCAASS RLrNPORCED PLASTIC ❑91 t1NKNOWN 445 nATF 7NSTALL611 as
<br /> l�may^^.:^onM ❑ItIMPRESSEDCL' nw C"OTHER
<br /> ❑z SACIURSr.IAL ANODE(
<br /> ..,..,
<br /> (Fu loa7 j.only)
<br /> SPILL AND OVERnLL vrARrNSTAI,LV50TYPE(Ixol,a..-:n u, OVER FILL PRO FCCTIONGQUrPMENTY"RINSTALLeD 177
<br /> (Cheek ml 4,.,.004) Q )SPILL CONTANMLN Ire✓I ALA
<br /> [� 2 DROP TUBE. I];FILL TUBE SHUT OFF VAL'
<br /> Q
<br /> ❑STRIKER PLATE "PALL F1 4 EXEMPT
<br /> FLOAT
<br /> ry•'TANK LEAK DETECTION IA aacllpsfon,n7d lroanonoy 9 Doom Iwl ke woa,md7o py Idwl,pey.)
<br /> IF SINGLE WALL)A_NX(CW,kIlrkAtppiy) ao, IFDOUDLEWALL TANK ORTANK WETIIBLADDER SIS{ '
<br /> ❑ (VISUAL(EKPo=PORTION ONLY) []5 MANUAL TANK GAUGING(MTG) (C-A am TIM mlyl
<br /> 12 z AVTONNriC T&NX On(GR•'G(A(0) ❑e vADOsr.7nN¢ E] I Vis JAL tsiNGLr WALL IN VAULT ONLY)
<br /> I] 3 CONTNUOV$A p 7 OROUNLIWAI er( ®2 COWIWUOL'S NT£ILC7ITIAL.vnmrTORNG
<br /> ❑4 STATISTICAL INVENTORY RECONCMIATION U STANK TESTING
<br /> 3 MANUAL.,[OM1tpRMG
<br /> (SIR)B:E�'7NIAL TANK TEST NO 0 99 OT)QA
<br /> v.TANK CLOSURE I.*4FOItMATIOy r PERAIANFNT CLOSURE IN PLACE
<br /> r��
<br /> oly (4STEMATE
<br /> TEDOATELASTUSED(V1tyNO1DAY) 000AN7ITYOFSUBSTANCE RCMANING <y( TA.NXFILLMWITH)NERTMATERrAl,? <70
<br /> .._..._^.^. ❑Yrk ❑N.
<br /> 1iP(.'F(1'/99 revised)
<br />
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