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04/17/2007 09:24 916-371-1172 WALTON ENGINEERING PAGE 03 D°� SI3(o7 M�ryjt�ank) 7IB`7UNIk'IEA PROGRAM CONSOLIDATED FORMTANKS `� Ji07 UNDERGROUND STORAGE TANKS - TANK (Two Pagn?P Page I of TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4,AMENDED PERMIT ❑ 5,CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK cw$vISE 45n (Check ors nam onlyl ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (.sm-Ify mnnan) (Spwy ranean) ® 8.TANK REMOVF,O BUSINESS NAME 15"m FACILITY NAME or DBA-Deng 0.11..,M) 3 FACILITY ID' Joe's Travel PlazaI LOCATION a O� D� 451. I. TANK D.tSCR;IMOrit - �7od l6l 19n vJithil rhe YJ57'' P TANKIMANUFACTURF?R g idiN hn-433 d'�Ikntl1518hM ARTMENTALIZmm N1 1agE6 TA TANK ID it d71, g stein mcludln bU'i„ gY 'rothN IoCh K Yet; No 434, na5le1ulilcIOW13 (Y."eomplme one pn9a It"eachp4nmmn. DATE INSTALLED 4,15, TANK CAPACITY IN GAI.,LONS 476_ NUMBER OF COMPARTMENT- -(YEAR/MO) 431, Unknown 500 1 ADDITIONAL DESCRIPTION(Far l.iJ me only) 418 TANK USE mo. PETROLEUM TYPE . ❑ 1. MOTOR VEH)CLEFUEL ❑ In. REGULAR UNLEADRD ❑2. LEADED +4n ❑5. TET FIJEI. (Ifeheekad,mmplete Pmrolmm Type) ❑Ib. PREMTIM UNLEADED 03. DIESEL [:12. NON-FUEL PETROLEUM ❑6. AVIATION GAS ❑1c, MIDGRADE UNLEADED ❑4, GASOHOL 099.OTHER;Unknown ❑ 3. CHEMICAL PRODUCT COMMONNAME (hill 1441,1RINlMmerinle lnv tmy pegs) 441. CA'SO Hnznrdeun Mmndnl,,lmmnwry paW:J 447. ❑ 4. HAZARDOUS WASTE URICnown (Includes used ol6 ® 95.UNKNOWN ' �'Akll�CfINS"iiRl#7ETION. TYPE•OF TANK <SI 1. SINGLE WALL ❑3. STNOI,E WALL WITH EXTERIOR ❑V SINGLE WALL WITH INTERNAL BLADDER SYSTEM 141. (Check me item only) MEMBRANEL(NER CI 05. UNKNOWN [32 DOUBLE WALL ❑4, SINGLE WALL 1N A VAULT El 99. OTHER TANKMATBRIAL_pdmmymrk 201, BARE STEEL LJ 3. FIBERGLASS/PLASTIC 0 3. CONCRETE El 95.UNKNOWN 444. (Cheep one imm only? ❑2. STAINLESS STEEL ❑4, STEEL CLAD W/FIBERGLASS ❑a, FRP COMPATIBLE ❑99,OTHER: REINFORCED PLASTIC(FRP) W/100%h4ETNANOL TANK MATERIAL-8ccondnry look 1, BARE STEEL ❑3. FIBERGLASS/Pl„ASTIC S, FRPCOMPTIBLE W/IoOak METHANOL CI 96,UNKNOWN 445. (Check one itcm only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FMERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99,OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑S. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING S.CLASS LINING 95.UNKNOWN 446, DATE NSTALI..F.O ul. OR COATING ❑2,ALKYD LINING ❑4.PHENOLIC LINING ❑6,UNLINED [199.OTHr; Check one item only) OTHER CORROSION ❑L MANUFACTURED CATHODIC 0.1.FIBERGLASS REINFORCED PLASTIC ®95.UNKNOWN as. DATE INSTALLED a9. PROTECTION PROTECTION 04.IMPRESSED CURRENT CI 99.OTHER I(A liublc ❑2.SACRIFICIAL ANODE SPILI.AND OVERFILL YEAR INSTALLED 450. TYPE del. OVERFILL PROTECTION EQUIPMENT: YEARINSTALLED 45X. (Check all that apply) ❑ I.SPILL CONTAINMENT Unknown ❑I.ALARM ❑3,FILL TUBE SHUT OFF VALVE Unk ❑2.DROP TUBE Unknown ❑2.BALL FLOAT Q 4.EXEMPT ❑3.STRIKER PLATE Unknown .TAN LSA I1ETIE CT£ION ..... ' (.hAb4ctl�fibR nf,rhd nmitiitoindgpr '911NL'ElrisBhlnitiid:�aTlre:rom131 � ;.:; IF SINGLE WALL TANK 453. TF DOUBLE WALL TANK OR TANK WRH BLADDER 454 (Cbxk all that apply) (Cbmk me Item only) ❑I. VNIIAL(EXPG$ED PORTION ONLY) El 3.MANUAL TANK OAUGNO(INTO) ❑I,VISUAI,.(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6,VADOSE ZONE ❑2,CONTINUOUS INTERSTITIAL.MONITORING ❑3.CONTINUOUS ATG ❑7.OROUNDWATER ❑3.MANUAL MONT rORING ❑4, $TATM. ICAC.INVENTORY RECONCILIATION 0 S.TANK TF_STINO (SIR)+BIENNIAL TANK TESTING ®99.OTHER Unknown ty TANI9 CLOSM- NI ORMATION L ANENT CL09UIii!)E IN PLACR 1?FII1 ' ESTIMATED DATE LAST USED(YRM10/DAY) 455ESTIMATED OUANTITY OFSURgTANCE REMAINING 4stt 1 TANK FILLrD WITH INERT MATERIAL? 457 g.111.` ❑Yes ❑ No UPCFhwrwrc-b(1/99)-1/4 httpOwww.anldoucirg Rev.02/16/MI