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1 a FLED PROGRAM CONSOLIDATED FORM4P II\ ANK: TA0505679 .n. PR#: PR0231227 UNDERGROUND STORAGE TANKS - TANK PAGE 1 �. � FAC#: FAD004033 .�-S� (two pages per tank) TYPE OF ACTION INEW SITE PERMIT ❑ 4AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6TEMPO RYSITE SUIS a (Chmkes4iummly) ❑ [:17 PERMANE ED ON SITE2, I ❑ 3 RENEWAL PERMIT ❑8TANK REMOVED )A V BUSINESS NAME lame as FACILITY NAME w DBA-Doing Bminess As) FACILITY ID: PR#: I CIRCLE K STORES INC#2705449* FA0004033 PR0231227 LOCATION WITHIN SITE(opdooa) 7647 PACIFIC AVE,STOCKTON 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# Tank#: 5 432 TANK MANUFACTURER 433COMPARTMENTALIZED TANK [I Yes [IN. 434 TA0505679 XERXE$ a'vn",mmplem mepage f«each cwnpasmenr. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 5/22/1995 12:00:OOAM 12,000 ADDITIONAL DESCRIPTION(Fwlmaluse mh) 438 11.TANK CONTENTS TANK USE 434 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL N I a,REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ifmarkedoompleh Pcaolman T)Po) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ to MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(sewn Haawdooa MmwVals lnvenson page) 441 CAS#(Bmv Haaardms Mammals mewrwy page) 442 ❑4.HAZARDOUS WASTE (includes Uad Oil) ❑95.UNKNOWN HL TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (CMckarc imm mh) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN N 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ❑ 1.BARE STEEL N FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Cheek..o no.only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99,OTHER TANK MATERIAL-secondary look ❑ 1,BARE STEEL N 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Cheek one lmm mn) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8,FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Check ono Item mh') ❑2 ALKYD LINING ❑4 PHENOLIC LINING N 6 UNLINED ❑ 99.OTHER (Far tact ux mh) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 CNKNOWN 4411 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Cheek one item a ah) E:] 41MPRESSED CURRENT ❑ WOTHEA ❑ 25ACRIFICIAL ANODE (Fw lural use mh) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(Imaluseonh) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Cheek allNaz epph) N I SPILL CONTAINMENT 1,995.00 ❑ IALARM N 3 FILL TUBE SHUT OFF VAC 1,995.00 X❑ 2DROP TUBE 1,995.00 ❑ 2BALL ❑4EXEMPT XI 3STRIKER PLATE 1,995.00 FLOAT IV.TANK LEAK DETECTION(A dwcdpoon of ine=nssodng pro tom shell be submrtuH to me Imal agrnc,:) IF SINGLE WALL TANK(Chmk all Nal apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ S MANUAL TANK GAUGING(MTG) ((heek ones.only) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑ 6VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER N 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 451 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)