COMPLIANCE INFO_2002-2005 - Laserfiche WebLink

Home Browse Search

Aug 13 03 12:07p Richard Thompson 925-22G-2050 p.10 UNIFIED PROGRAM CONSOLIDATED FORM T NKS 8�asf 3 UNDERGROUND STORAGE TANKS -TANK PAGE 1 (nro pager per tank) Paye _of_ TYPE OF ACTION ❑ L NEW SITE PERMIT ❑4. AMET'DED PERMTr 05, CHANCE OF INFORMATION) ❑6. TEMPORARY STIE CLOSURE (Check rare item only) [17. PERMANENTLY CLOSED ON SITE ❑3. RENEWALPLRMIT - ❑8. TANK REMOVED 430 (S� ecify� resa �an - fr)rincu! use only) /.Specifycharge -fru local use Ono BUSINESS NAME(Sluncas FACILETYNAME or DBA -Doing Business As) 3 FACIUTYIDu I Circle K Stores, Inc. 42705446 LOCATIONwTDI1NSITE nano%�^ 431 y CW_e, 4L43 I rte ✓ t! i) J S "�%. i t 'D -j �. rL-i�) -.y .J L TANK DESCRIPTION M scaled plar pkm with the location afthe OT.ryetem including huikGbgs and kindmarks shall be mrhmitted to the focal agency.) TANK IDN ' 432 TANK M IJFACTURER 433 COMPARTMENTALIZED TAMC ❑ Yes No 434 If UYcsi7, comPlek one foreach com ail. (` page DATE INSTALLED (YFAR/MO) 435 TANKCAPA INGALLONS 436 NUMBFROr COMPARTMENTS 437 ADDITIONAL DESCRIPTION (P6, k.1 uur only) 439 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 I. MOITIRVEFDCLE FUEL la REGULAR UNLEADED ❑ 2. LEADED ❑ 5. TET FUEL J ids J.amtioktc liar kma 7ypcl lb. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. .4YIATION FLTL ❑ Z NON-FUPLPEIROLEUM ❑ le MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME (f, HanahlawMaremalt In"forvpage) 441 CAS fi(Jrom Hazardous Mmertaks ln�torypage) 442 ❑ 4. HAZARDOUS WASTE(lneludes Ucd 00 ❑ 95. XERXFS UL TANK CONSTRUCTION SINGLE WALL ❑ 3. SINGLE WALL WRH ❑ 5. SINGLE WALL WITH INTERNAL INTERNAL BLADDER SYSTEM 443 TYPE OF TANK�❑� `1. DOUBLE, WALL EXTERIOR MEMBRANELWER [19!LXES 99. XER (('hcckanrltemonlyj / \ ❑ 4. SINGLE WAIL IN A VAULT [:199. OTHER,-_�_�a TANK MATERIAL- Pmr+Y tank ❑ 1. BARE STEEL3. FIBERGLASS / PLASTIC 05. CONCRETE ❑95. XERXES 444 ❑2. SI'AINLESSSTEEL . TEELCLADW/FIBERGLASS [:IS. FRPCOMPATT LEW/IWAMFMANOL [199. OTHER (Clnr3cwritcmanyJ REINFORCED PLASTIC (FRP) TANK MATERIAL -secondary tank ❑ 1. BARE STEEL 3. FIBERGLASS / PLASTIC ❑8. FRP COMPATIBLE W1100•A MEDIANOL ❑95. XERXES 445 ❑2. SfAINLESSSIFFL 4. STEELCLAD WNMERGLASS ❑9. FRPNON-CORRODIBLEIACKEr 099. Dn4m_� _. ((:hcttnreeitcmony) REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL 05. CONCRETE TANK INTERIOR LINING ❑ 1, RUBBER LINT:D ❑3. EPDXY LJNING 05. GLASS LINING ❑95. XERXfS 446 DATE INSTALLED 447 ORCOATING 02 ALKYDLINING 04. PHENOLIC LINING UNLINED [19.). OTHER _ Check ore item onA9 Fru k,cvl use curly) OTHER CORROSION Ell . MANUFACTURED 3. FIBERGLASS REINFORCED PLASTIC ❑95. XERXES 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE CATHODIC 4, IMPRESSED CURRENT ❑99. OTHER _ PROTECTION f( het* one iron only) 02 SACRIFICIAL ANODE or local rise an, ) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE a,!;rkxvl ure only) 451 t' SPILL COM UNMENT � �L'' OVERFILL PROTECTION EQ 4Ew; YEAR INSTALLED p 452 ❑ 1. ALARM FILL TUBE SHUT OFF VALVE I -- T- (('hecko0 tlar apply) DROPTUBE J fL []I. BALLFTOAT r' ❑4. EXEMPT STRIKER PLATE W. TANK LEAKDETECTION (A ckuaiption ojthe monitariagprognam.sallbesubmiued to the localagency) IF SINGLE WALL TANK ON that apply), 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Chedrone item en y): 454 ❑I, VISUAL (EXPOSED PORTION ONLY) ❑5. MANUAL TANK GAUGING( MIG) ❑I. VISUAL (SINGLE WALLIN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6. VADOSEZONE '2. CONTINUOUS INTERSTITIAL MONITORING 03. CONTINUOUS ATG ❑7. GROUNDWATER �13. MANUALMONITORING 04 ST\TISTTCALINVENFORYRECONCIUATION(SIR)+ ❑8 TANKTIS TING BIENMAL TANK TESTING []99. OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MOJDAY) 455 ESTIMATED QUANTTIY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL7 457 Q Ya ❑ No a>Ibns