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FEB-07-2001 WED 03:46 PM QUIK STOP MKTS INC FAX NO. 51065(1544 F. Ub ED PROGRAMA CONSOLIDATED FOR TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages por tank) Rage.. •,at TYPE OF ACTION 13 1 NEW SITE PERMIT © 4 AML"NDED PGRMIT [] 6 CHANGE OF INFORMATION Cl 6 TEMPORARY SITE CLOSURE (] 7 PERMANENTLY CLOSED ON SITE (Cheek one Ilrn1 only) 430 D 3 RENEWAL PERMIT (Spoury reason-fur local use 0111Y) (Spocity,reason-ter local u: ❑ 6 TANK REMOVED a only) t BUSINESS NAME(Snmc a-3 FACILITY NAME or DOA-Oolnp Duslnoas A) 9 FACILITY{D: Quik Stop Market#132 431 LOCATION WITHIN SITE(Optional) �.. -�,- I.TANK DESCRIPTION (A scale(I plot plias with the location of the USgTn Ystem netud'tt8 buildings and landmarks shat)be submitted(o the(oca TANK ID# 432 TANK AM NUFAGTURER 493 COMPARTMENTALIZFD TANK ❑Yes NO 434 If"Yes',complete one page for each cumpartmcnl. Xerxes 43G NUMBER OF COMPARTMENTS 437 DATE IN ATS LLED 411 "fANK(:APACITY IN GALLONS (YGAR/MO) 430 5000 1 19911Januar __„ AE)uITIONALDESCRIPTION(Fprlocaluseonly) --- �. T11, NK CONTENTS 440 TANK USE 439 PETROLEUM TYPE 1a. REGULAR UNLEADED ❑2, LEADED [S 5, JET FUEL S)1. MOTOR VEHICLE YUEL D 6. AVIATION FUEL (Itnvrkod conplotc P(,,oleumType) ®1b. PREMIUM UNLEADED (�3, DIESEL ❑ s oTl�eR I]2. NON-FULL P�ROLEUM to 1c. MIDGRADE UNLEADED ©4. GASOHOL 441 ❑99.OCASprom i lalardous KIterlals Inventory pa(3c) 442 ❑3. CI•IEMICAL PRODUCT COMMON NAME prom Hnzardw+g Malcnulo Inventory page) 800 (iron o Cl 4. FIAZARDOUS WASTE Unleaded GasOline Premiurn, 92 Octane (Includvz u3ad Oil) []95.UNKNOWN IH. TANK CONSTRUCTION TYPE 0 TF WK (�1. SINGLE-WAIL © 1,SIN"WALL WITH n5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chock ane Ilam only) EXTERIOR MEMBRANE LINER []96. UNKNOWN 2, DOUBLE WALL Q 4. SIGNLE WALL IN VAULT ❑99. OTHER_ fANK MAl IoRIAL-prlmurY tank []1• DARE STEtL 3, FIBERGLASS!PLASTIC (�5. CONCRE 1'E []96. UNKNOWN 444 tchut*one Itcm ady) Q 2. STAINLESS STEEL 0 4. STEEL CLAD WIFIBERGLASS CR a. FRP COMPATIBLE W/ Q 99,OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK NNTERIAL-cncMidarytank [�1. EIARE STEEL 3, FIBERGLASS I PLASTIC Q 5. CONCRETE ❑95, UNKNOWN 445 (ClteGc ono Ilam only) [12. STAINLESS STEEL Q 4•STEEL CLAD W/FIBERGLASS Ig 9. FRP COMPATIBLE L7 99.OTHER REINFORCED PLASTIC(FRP) W/100%u METHANOL ❑5. CONCRETSe Q 10.COATED STEEL qq0 DATE INSTALLED n4Y w TANK INTF,RIOR LINI140 ❑1. RUBS It [13.EPDXY LINING Q 5.CLASS LINING 9a.UNKNOWN OR COATING []2 ALKYD LINING ❑4 PHENOLIC LINING a 0 UNLINED ❑99 OTHER --��(For local use only) (Chock ani.Hent only) 449 DATE INSTALLED 449 GTHL'h!CORRGSIGN LI 1 MANUFACI URED CATHODIC 0 3 FIBERG4ASS R[INFORCED PLASTIC ❑95 UNKNOWN 41MPRESSED CURRENT Q 99 OTHER PROTECTION IF APPLICABLE PROTECTION ❑ (Por lwa use only) (Check ono item only) ©2 SACRIFICIAL ANODE 452 YUF INSTALLED 450 TYPE(Iuea1 Lao 4b1 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED SPILL/IND OVLI2FIL�w only) (chuck all ®1 SPILL CONTAINMENT 1 gg3 ❑1 ALARM ®3 FILL TUBE SHUT OFF VALVE: /c/9',? uiol apply) �� t-'echo Q 2 BALL FLOAT Q 4 EXEMPT 2 DROn TU135 1993 .W Q] $STRIKER PLATE 1991 IV.TANK LEAK OFTECTION(A doscripku0 or the monilodng prourunt shall be aubrra«ed to the local agency.) 454 459 IF DOUBLE WALL TANK OR TANK WITH BLADDER ffSINGL�pWALL TANK(check allliwtopply) (chock one dem only)r'OSED PORTION QNLY} ❑6 MANUAL TANK GAUGING(MTG) Q I VISUAL(SINGLE WALL IN VAULT ONLY) TIC TANK GAUGING(ATG) ❑6 VADOS7 ZONE 10 2 CONTINUOUS INTERSTITIAL MONITORING 0 3 CONTINUOUS ATG Q 7 GROIJNDWAI CR 0 3 MANUAL MONITORING El h S•rATISTICAL INVENTORY RECONCILIATION Q a TANK TESTING k(SIR) 615NNIAL TANK TESTING ❑99 OTHER -T- IV.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 4bG ESTIMATED QUANTfrY OF Si kbSTANCC 456 TANK FILLED WITI I INERT MATCI�IAL? 457 FST IMATED DATE LAST USED(YR/MOIDAY) REMAINING Formorly SWRCt3 Form 8 UPCF (1199 reviscf]) •