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IED PROGRAM CONSOLIDATED FORM TANK: TA0506322 PH#: PR0231435 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0000916 (two pages per tank) TYPE OF ACTION ❑ ]NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION Page 4 of] Click mJ 1 only) ❑ 6 TEMPORARY SITE CLOSURE (Sptt 5 reason forb-1 I-mdvl ❑ ]PERMANENTLY CLOSED ON SITE 3 RENEWAL PERMIT - lsVcrAly mmv f I hvmnlyl R ❑ STANK REMOVED 43o I l BI)SINESSNAME(Bameaz FACILITj�NK EANFA FACILITY ID PIt: 7 ELEVEN#19976* FA0000916 PRo231435 Q LOCATION WITHIN SITE(OP._ CA V 431 PHONE I.TANK DESCRIPtion of the UST system including buildings and landmarks shall be subinined m the local agency.) TANKID# Tank#: 5NRER 433 COMPARTMENTALIZED TANKTA0506322 Yes ❑No 434CONTAINMENTv«^, ampweomgxcampmmt.DATE INSTALLED( 0) IN GALLONS 436 NUMBER OF COMPARTMENTS 9/20/1996 637 10 000 ADDITIONAL DESCRIPTION(Pm lo«I me oNy) 438 5I RJD7 TANK USE 439 PETROLEUM TYPE 11.TANK CONTENTS ® I.MOTOR VEHICLE FUEL (T la.REGULAR UNLEADED ❑ 2.LEADEDEL 440 0fmmkMPw Wp Pwok Type) El ❑ S. TIIb.PREMIUM UNLEADED El3.DIESEL E] AVIA 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED El 3.CHEMICAL PRODUCT ❑4.GASOHOL ❑ 99.OTHER COMMONNAME(rmm xa:armor mamda61mm1oypage) y�l CAS#(6vm xazadom mamiav lmmtoy page) E]4.HAZARDOUS WASTE aaz (Imlme5 uazd on) MID UNLEADED ❑95.UNKNOWN HI.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM a3 (Click ave nam only) EXTERIOR MEMBRANE LINER ❑95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ® I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (C on<n®only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100-A METHANOL REINFORCED PLASTIC(FRP) [199.OTHER TANK MATERIAL-secondary tank ❑ L BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN a45 (Check om item Doty) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/1009n ETHANOL REINFORCED PLASTIC(FRP) ❑ I0.COATED STEEL I/h99.ITS� � L ❑ 5.CONCRETE TANK INTERIOR LMMG 1.RUBBER LINED ❑ 5.GLASS LINING OR COATING ❑ ❑3.EPDXY LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 (CMxk am i monN) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑ 99.OTHER (F«Ixzl me only) OTHER CORROSION ® I MANUFACTURING CATHODIC PROTECTION IF APPLICABLE PROTECTION ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED d49 (Click one it=my) ❑2 SACRIFICIAL ANODE ❑ 41MPRESSED CURRENT ❑ 99 OTHER (Pmbwl umanty) SPILL AND OVE L YEAR INSTALLE450 TYPE(malmeoNy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chckall this y) I SPILL CONTAINMENT 2 DROP TUBE 151 fu I ALARM � ❑� 3 FILL TUBE SHUT OFF VAL` 'fR''I 2 BALL LTL E]4 EXEMPT 35TRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A d««ipdon ofdte m ftorngproaam amllbe5&maW m Nc Ia«I agemyI IF SINGLE WALL TANK(Clwlt all not apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Qrck ai am only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑3 CONTINUOUS ATG ❑ ]GROUNDWATER 912 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER ❑3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)