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HomeMy WebLinkAboutMO-1370_0_CA_UST-3_19940106FOR North Carolina - Department of Erwironmert, HeaM),cW�,M,`�ybrJrq'Aw es State i �iMENT, HEALTH , ,YANKS Division of Emirorxnental Management - Gr tf�" a��a �i r WX UAL RESOURCES IN P.O. Box 27687 .N01%.,nt� � � �pn� � I. D. Number N Raleigh, NC 27611 (919)73�r=8303 O 1`39� �k Date Recei WN _ INSTRUCTIONS r t, E4i+FR� Please complete and return thirty (30)., $"Pri*3 211 anently dosing tank(sp)NON OF ENVII?ONMENTAL Wlii10EME 1. OWNERSHIP OF TANK(S) U., IL LOCATION OF TANK(S) Tank Owner Name: (! ayo 't-�rz., 4�0 . _Facility Name or Company: K -Tv fie= (Cf!e*n, IrxfML4 Pubic Agency, or Other. Fntry Street Address: `75� I i C-) C, a9 1 Street Addre --r State Toad: ry fie- nd d- County: C4_16Ao�' rL t-5 CountyCIA City: COO t) TzJ State:_ J�Zip Code: 02 602s City: V<aj i S State: QC— Zip Code: 02 808 I Telephone Number (Area Code): r 6_� - `­1 g9,- 3l q (- Telephone Number (Area Code): r- Contact Person Name: VorJe�r+ �a rbowti' Job Title:6D• Super✓r -5�y­ Telephone Number:( 7cq-) M2- 3(9(, TANK REMOVAL OR CLOSURE IN PLACE 1. Contact Local Fire Marshall. 4. Remove Tanks or Close in Place in a Safe 5. Provide a sketch Locating 2. Plan the Closure Event. and Secure Manner Per API Pubs. "2015 Tanks and Soil Tests. 3. Make Site Soil Assessments. Cleaning" and "1604 Removal & Disposal". 6. Keep Records for 3 Years. TANK(S) CLOSURE OPERATIONS TO BE PERFORMED BY: (Contractor) Name: et�y,' ro - T(Lf1 `K___ Address, � � Bc) (__ a as State e,,-) 5 � C-- Zip Code 916(0 & Contact: I�r ( (�S Phone: qCD q-- eA(- Co 00c, 1 TANK(S) SCHEDULED FOR CLOSURE OR TO BE CLOSED TANK NUMBER TANK ID # TANK CAPACfrY LAST CONTENTS CLOSURE METHOD_ Remove Close in Ground Tank 1 Tank 2 l� Tank 3 l� Tank 4 0 Tank 5 0 Tank 6 O O Tank 7 O Tank 8 O O Tank 9 O O Name and Official title of Owners AL&ffaed Representative c r 0t)e t'a�ClofJ5 4 cA L V&5or'Scheduled Removal Date: gh Signature: Date Submitted: �v 'N whedijied removal dale changes, Fo V egfit hays verbal notice of lark removal is wFired GW/U ST-? copy - Lmner blue wEry - +,1-_t11uc' vrircz K-TOWN STORE CENTERGROVE RD (DALE EARNHARDT)& UTAH 0-019494 NOI SUBMITTED DATED 1/06/94 FOR ONE UST REGISTRATION DBASE INDICATES THAT 1-550 KERO TANK WAS REMOVED FROM SERVICE 6/30/94 NO TANK CLOSURE REPORT RECEIVED, ROBBY BARBOUR SAID NO 550 TANK EVER PRESENT EGL 10/18/05 LO 0 0 N ti 0 r CL N 'v (�. LL T 00 T 00 T co T 0o T 00 0 0 0 0 0 0 0 0 0 0 N N N N N d m rr 07 U c6 U'UUUUU z z z z z V U) U) co co 07 w J J .J J J LM "- O O O O O aCLILaa z z z z z 0 0 0 0 0 of w N\w\ \w\ \w\ \w\ \w\ '-00000 of W- w of Q(D(D000 _ w w w of w of w u. I-- z z z z z w w w w w U U U U U N N N N N 00 T 00 T 00 T 00 T 00 T m Z_w/ Z W NwN Nam. NwN w mow�// Ix NwN w MOOOOLOO VJ V! vJ VJ VJ z z z 2z J 2z 00 00 0 L0L L0 'a v as rn It rn It rn d' rn d rn Nr u_aarnrnrnrn r 00 T T 0 T 00 T 1 1 0 I 0 1 0 1 0 0 R:4 'a hl v N r.� I L Ln O O N ti T O T co M M 0 0 (0 C0 (0 00 00 O O O O O T T T r T LO LO LO LO LO r- T N 1 c+M d' Lo viI T T r T T C O T OIO T T O r O T CL N N N N N L. 00 00 00 00 00 � ti ti � ti ti O O O O O ti ti'� ti ti N N N N N O O O O O 00 00 00 00 00 N N N N N UUUUIU Z Z Z Z Z M O co a- 00©©IM v 0 m