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Aug 13 03 12:06p Richard Thompson 925-2 26-2050 p.8 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 SI -7-0-3 (twopages per funk) Page ` of_ TYPE OF ACRON ❑ 1. NEW SITE PERMIT O4. AMENDED PERMIT ® 5 CHANGE OF INFORMATION) ❑6. TEMP(MARY SITE• CLOSURE ((:/a.•ck erre item at*) ❑ 7. PERMANENTLY CLOSED ON SITE ❑3. RENEWAL Pm- irr-- ❑8. TANK REMOVED 430 (.1�cifv mason -for local ace any) (Spxrify cltatlbe-for local EM only) BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FACILITY ID k 1 Circle K Stores, Inc. #2705446 X14 b �%?� -L L- IT TF IJ3CA,R WITHIN SITE (f)ptlmml) � ( 431 +1 � 4 n 'v1 L TANK D ESCRIPTION (A scakrl pkn plan with the kxotion of the UST .y siem itrchiding buildings and lornInwis shall be submitted to the lxol agurcy) ' TANKiD* 432 TANK MANUFA7�jR /� 433 COMPARTMENTALUEDTANK Yes No 434 lAR/M/ /S� h i ` r V 4� j r'; /1 1G7 t c+• / If i7yesC, complete one page fbt ecwh a mt DATE INSTALLED (YE O) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 '^ A I 10 1 ADDMO14AL DESCRIPTION(F'orlrxal..*) 438 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 t MOTOR VEHICLG FUEL ❑ 1. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL. _ f , awipietc PeimleumType) ❑ Ih. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM . MMCRADE UNLEADED ❑ 4. GASOHOL ❑ 99 OTHER ❑ 3, CHEMICAL PRODUCT COMMON NAME()romBaxndau.r.MareriaA lnwnj rypagw) 441 CAS d(fnmt Hxatdmts Maietiah lnvenlorppax�) 442 ❑ 4. HALSRDOUS WASSTE(Jncbrdex Used 0tl) ❑ 95. XERXES IIL TANK CONSTRUCTION TYPE OF TANK ❑I STNGLEWALL ❑ 3. SINGLEWALL WITH ❑ 5. SINGLE WALL \YIT}IINTERNAL BLADDER SYSTEM 443 DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95, XERXES ((:heck one ilwn only) ❑ 4. SINGLE WALL. IN A VAULT ❑ 99. OTHER .��.. TANK MATERIAL -primary tank ❑1. BARE$[LEL 1BERGLASS/PLASTIC ❑5. CONCRETE ❑95. XERXES 444 ❑2. STAINLESS STEEL []4 STECI. CLAD W/FIBIRGLASS 08. FRPCOMPATIBLEW/IIXPYeMMIANOL [199. OTHER (C.hati*ntoe iteM anly) REINFORCED PLASTIC (FRP) TANK MATERIAL -sceond tank ❑l. BARE STEEL BERGLASS/PLASTIC ❑S. FRPCO,VIPATIBLEW1I00P/_mETHANOL ❑95_ XUtJCES 445 ❑2. STAINLESS STEFl, ❑4. STEEL CLAD WIFIBERGLASS ❑9. FRPNON-CORRODIBLEJACKEr ❑99. OTHER (Cleekane lton only) REINFORCED PLASTIC(FRP) ❑T0. COATEDSIEEL Els CONCRETE TANK INTFRIORLINING ❑ I RUBBER LINED ❑3 EPDXY LINING ❑5. GLASS LINING ❑95. XERXES 446 DATE INSTALLED 447 OR COATING ❑2. ALKYD LlNitx ❑4. PHENOLIC LINING -G UNLINED ❑99. OTHER Il'heck one item only) ror burl ace tndr OTHERCORROSION I. MANUFAcruRED •IBERGL.ASSREINFORCED PLASTIC 095. XERXES 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE CATHODIC ❑4. IMPRESSED CURItL•NT 099. OTHER PROTECTION -- ((.heckorrettemonly) 02. SACRIFICIAL ANODE (lar locolaw only) SPILL AND OVERFILL YEARINSTALLED 450 'TYPE()•hrkw.alw•eony) 451 I. SPILCONTAINMENTL C� OVERFILL PROTECTION EQURWF-\T. YEAR IWTALLPD 452 01. ALARM 3. FIILTUBESHITTOFFVALVE (Chex* all that appy) DROP TUBE - Z BALL FLOAT ❑4. EXEMPT . STRIKER PLATE L:. N ;4' IV, TANK LEAK DETECTION(Aduc)lpiianofthemoniluriti;prognm.+'mu&submltedto thekxxdq&rry.J EF SINGLE WALL TANK (Check aflthal appy): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Clrack ane iron rsn/y): 454 ❑ I, VISUAL (EXPOSEDPDRTTON ONLY) []5- MANUAL TANK GAUGING (PTTs) ❑ I. VISUAL (SINGLE WALL IN VAULT ONLY) 02. AUTOMATIC TANK GAU'GNG(ATG) ❑6. VADOSEZONE CONTINUOUS INTERSTLTiALMONITORING ❑3. CO\TINUOUS ATG ❑7. GROUNDWATER ❑3. MANUAL MONITORING ❑4. STATISTICALLNVENR)RYRECONCI,IATION(SIR)- ❑8. TANKTEsTTNG BIENNIAL TANK TESTING ❑99. OTIRR V -TANK CLOSURE INFORMATK)N /PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (MMO/DAY) 455 1-SDMATED QUANTITY OF SUBSTANCE REMAINING 456 TANTO FILLED W rTM INERTMATERIAL7 457 ❑ Yes ❑ Xo