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ANK: TA0505681 FIED PROGRAM CONSOLIDATED FORM p� ` PR#; eno231227 ,,�c, FAC#: FA0004033 UNDERGROUND STORAGE TANKS -TANK PAGE I1j (two pa es eI tan ) Page fi of9 TYPE OF ACTION ❑ 1NEW SITE PERMIT ❑ 4 AMENDED PER ❑ 5 CHANGE OF INFORMATION ❑ 6TEMP Ys ,yOssIIUU11 RE (Check wy nm.aay) ❑ ]PERMANENTLY 0 {j ON� GI _ -- -a, 430 (Spec 11 rw;on 4m lanl ooly)_ lSpcc[ rwsun far lwal oma only) ❑ eTANK REMOVED ❑ 3RENEWAL PERMIT ... I FACILITY ID. PR#: BUSMSSNAME(Saaea FACILITYNAMEm DBA-Wing Bareness As) 3 FA0004033 PRO231227 CIRCLE K STORES INC#2705449* 431 LOCATION WITHIN SITE(opom,a0 7647 PACIFIC AVE,STOCKTON PHONE I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildingCsONdP1d MEklsTsrh� ED TANIKto the local O Y«,) ❑No 434 TANK ID# Tank#: 7 4321 ACT'l1RER 433 TA0505681 XERXES H•Ya',aomvlaa ae vae=fanaomvwrcat. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 433 5/22/1995 12:00:OOAM 12,000 438 ADDITIONAL DESCRIPTION(Fa.Iacd ac my) IL TANK CONTENTS "a TANK USE 43g PETROLEUIT TYPELEADED ❑ 5 BET FUEL ® 1.MOTOR VEHICLE FUEL ❑ R REGULARUN2.LEADED ❑ (Ifmukdwmpmw eWvleum Type) ® Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑4.GASOHOL 99.OTHER 3.CHEMICAL PRODUCT CAS#(tram H. .done Ma vialalmmwrypagc) 442 ❑ COMMON NAME(fmm xaaa.aoaa Mamnals mvrnwry pogo) aaI ❑4.HAZARDOUS WASTE naclWa Used Oil) ❑ 95.UNKNOWN HL TANKCONSTRUCTION 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 TYPE OF TANK ❑ 1.SINGLE WALL ❑ EX ERIOR MEMBRANE LINER ❑ ❑95.UNKNOWN (Chmkaeiemmav) 4.SINGLE WALLIN VAULT ❑ 99.OTHER ®2.DOUBLE WALL ❑ 4q4 TANK MATERIAL-primary tank ❑ I.BARE STEEL M FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 2.STAINLESS STEEL E] STEEL CLAD W/FIBERGLASS E] 8.FRP COMPTIBLE W/too-/.METHANOL (Creak me iwm mly) ❑ REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL M 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Clerk oao imn.1y) ❑2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ B.FRP COMPTIBLE W/loo'/.METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE 441 TANK INTERIOR LINING ❑ I.RUBBERLINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED OR COATING [] 99.OTHER (Cheek an<itaa ony) ❑ 2 ALKYD LINING ❑ 4PHENOLIC LINING M 6UNLINED (Fa WW ac any) 449 OTHERCORROSION ❑ I MANUFACTURING CATHODIC M 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Fm laaluuanp) (Check me iwm only) ❑ 2 SACRIFICIAL ANODE SPILL AND OVERFILL YEARINSTALLE45a TYPE(Iac4lanony) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all Nm appb) M 1 SPILL CONTAINMENT 1,995.00 [31 ALARM M 3 FILL TUBE SHUT OFF VAL` 1,995.00 ❑X 2 DROP TUBE 1,995.00 F1 BALL ❑ 4 EXEMPT ❑X 35TRIKER PLATE 1,995.00 FLOAT IV.TANK LEAK DETECTION(A aaIcai orae moniwdng pmgam shall M sabmhvd was keal agency.) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 IF SINGLE WALL TANK(Clack all 0,a111,) (Chinko itanma.) ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑6VADOSE ZONE ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER M 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑W OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 451 ESTIMATED DATE LAST USED(YR/MO/DAY) ❑Yea ❑ No UPCF(12/99 revised)