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Akk UNIFIED PROGRAM CONSOLIDATED FORM V� UNDERGROUND STORAGE TANKS-TANKPAGE 2 2`&;;,- i TANKS (rvo pogo per rank/ TYPE OF ACTION ❑I. NEWSITEPERMIT ❑4. AMENDEDPERMITPaged ®5. CHANGE OF INFORMATION) ❑b. TEMPORARY EITE CLOSURE (Check one item mrly) ❑3RENEWAL PERMIT ❑7. PERMANENTLY CLOSED ON SITE . . (SpecfY reosan-foea r(Dl use only) /Specify change-fw Inca,use only) 08TANKREMOVED 430 BUSINESS NAME S.as FACILITY NAME or DBA-Doing Busmen,An) ] 1 FACILITY ID M 1 Circle K Stores, Inc. #2705449/05449 LOCATION WITHIN SITE(Optional/ 431 I.TANK DESCRIPTION (Ascaledplotplan with the location of the USTvysram including buildings andlandmnrks shall bevubmitred ro the local agency) TANK IDP 432TANKMANUF CT /SURER 433 COMPARTMENTALIZED TANK El No 434 p C If UYeaO,complete one page for each on anment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY M GALLONS 436 NUMBER OF CO ARTMENTS 437 S 001) ADDITIONAL DESCRIPTION(F.,frea/use only) 438 11.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 I. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (Ifmarkad,complete Petroleum Type) ❑IE. PREMIUM UNLEADED El 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON-PUELPETROLEUM �gle MIDGRADE UNLEADED ❑ 4. GASOHOL PROD ❑3 CHEMICAL UCT ❑99. OTHER ❑ 4. HAZARDOUS WASTE!includes COMMON NAME(/rom Hazardous Mmerfah Inventory page) 441 CAS MU om Hazardous Mmennls Invenro Or&Oil) rypage) 442 ❑95. XERXES III.TANK CONSTRUCTION TYPEOFTANK ❑1 SINGLE WALL ❑ 3. SMGLEWALLWITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one two oral") 2. DOUBLE WALL EXTERIOR MEMBRANE LMER ❑93. XERXEB ❑ 4. SINGLE WALL M A VAULT ❑99, OTHER TANK MATERIAL-prinusy tank ❑1. BARE STEEL 3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. XERXES 444 (Checkon,hasennly) ❑2. STAINLESS STEEL 4. STEEL CLAD W/FBERGLASS 08. PRP COMPATIBLE W[100%METHANOL ❑99. OTHER REINFORCED PLASTIC FRP TANK MATERIAL-secondary taak ❑1 BARE STEEL FIBERGLASS/PLASTIC ❑8. FRP COMPATIBLE W/1 OVA METHANOL ❑95. XERXES 445 (Chock one item only) ❑2. STAINLESS STEEL 4. STEEL CLAD W/FIBERGIASS ❑9. FRPNON-CORRODIBLEJACKET ❑99. OTHER REINFORCED PLASTIC(FRP) [110 COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑3. EPDXY LINING OR COATING E12. ALKYD LINING ❑5 GLASS LINING E395. XERXES 446 DATE INSTALLED 447 ❑4. PHENOLIC LINING ❑99. OTHER Checkone RR oral Far Inca!use onl PROTEOTHERCTION IF PP ❑1. MANUFACTURED 3, FIBERGLASS REINFORCED PLASTIC ❑95. Usuals 448 DATE INSTALLED 449 PROTECTION ff APPLICABLE CATHODIC /Check one item only) PROTECTION 4. IMPRESSED CURRENT [:199. OTHER ❑2. SACRIFICIAL ANODE (For total ueonly) SPILL AND OVERFILL YEAR INSTALLED. 450 TYPE(For local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR MSTALLED 452 (Checkalltharapply) SPILL CONTAINMENT []I. ALARM `�rC��'(3. FILL TUBE SHAT OFF VALVE DROP TUBE S� ❑ / 2. BALLFLOAT LJ4. EXEMPT STRIKER PLATE IV. TANK LEAK DETECTION (A dascryahan area,monitonng angmm shall be submarrat to the local agency.) IF SINGLE WALL TANK(Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Cheek one item only): 454 01, VISUAL(EXPOSED PORTION ONLY) [15 MANUAL TANK GAUGING(MTG) ❑1. VISUAL(SINGLE WALL M VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) E:16. VADOSE ZONE ❑3. CONTINUOUS ATG CONTINUOUS INTERSTITIAL MONITORING❑7. GROUNDWATER ❑3. MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ ❑8. TANK TESTING BIENNIALTANKTESTMG ❑99. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILI.HD WITH INERT MATERW.7 457 Rollo. ❑Yes ❑No UPCF(1/99 revised) Formerly SWRCB Form B