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Aug 13 03 12:08p R' hard Thompson 92,9�-,226-2050 p.12 UNIFIED PROGRAM CONSOLIDATED FORM TANKS / e/�s/v� UNDERGROUND STORAGE TANKS - TANK PAGE i 0- pages per I-) Paye TYPE OFA(7nON ❑1. NEWSUEPERAIR 04. AMENDEDPERMIT ®5. CHANGE OFTNFORMATION) 06. TEMPORARYSr[ECLOSURE (Chcck om !tom on4) 07. PERMANENTLY CLOSED ON SITE ❑3. RENEWAL PERINITT _ E18. TANK REMOVED 430 (snrGjy'r'aNUr -jar knYJI mwonly) (SP �ejy rltartgr -far foeaduse nnN) BUSINESS NAME (Same az FACILITY NAME or DBA - Doiny 13usineas As) 3 FACILITY fD d 1 Circle K Stores, Inc. #2705446 LOCATION SIM (O 1J 1 / 431 1. TANK DESCRIP rION (A sw6xl plaf p1m wth the location ojtice GUT..Vem inchulrnf; /uiWing.vand hnrinvub whall&.ru6mieted to d+e kxnl agauy) TANK ID k A 432 q[q� � l I TANK TA ACIURER l 433 COMPARTMENTALIZEDTANK ❑ Yes No 434 compktc one ror each com L YY �`sIr7Ye50, l pa®c DATEINSTA - (YEA1`gRR(d0) 435 C I ( TANK CAPACITY IN GALLON'S 436 � i/ L' NUMBER OF COMPARTMENTS 437 ADDITIONAL DESCRIFIION(&r kxalusr rm/y) 438 11. TANK CONTENTS TAMC USE 439PETROLE1 M TYPE 440 MOTOR VEHICLE FUEL ❑ la. REGULARUNT,EADED ❑ 2 LEADED ❑ 5. JEFFUEL luta-d,mmpkiePeirokmType) ❑ 1h. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2 NON -FUEL PETROLEUM ❑ In. MMGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER --�-_� ❑ . CHEMICAL PRODUCT COMMON NAME(fmrt Haardom Marenals Invenrorypogc) 441 CAS #(firom Hazardous Materials lnvenrnrypage) 442 . HAZARDOUS WASTE (dnchuks l tsmOil) ❑ 95. XERXES III. TANK CONSTRUCTION TYPE OF TANK ❑I. SINGLE WALL ❑ 3. SINGLEWALLWRH ❑ 5. SINGLE WALL WITH INTfRNALBLADDERSYSTEM 443 EXTERIOR MEMBRANE LINER DOUBLEWALL ❑95. XERXES (('hrckone:trm ❑ 4. SINGLE WALL IN A VAULT ❑ qg. OTHER TANK 14ATERIAL - primary lank ❑ 1. BARE STEEL.FIBERGLASS f PLASITC [15. CONCRETE ❑ 95. XERXES 444 E17.STAINLESSSMEL ❑4. STEE,CLADWtFIBERGLASS ❑8. FRP COMPATIBLE W/IWI. METHANOL ❑99. OTHER—— (Chock one Turn only) REINFORCE) PLASTIC (FAP) TANK MATERIAL -secandmy tank ❑I. BARE STEEL / FIBERGLASS, PLASTIC 08. FRPCOMPA71BLEW110DV.METHANOL ❑95. XERXES 445 ❑2. STAINLESS STEEL ❑4. s-EELCLADW/FBERGLASS 09. FRPNON-CORRODBLEJACKET ❑99. OTHER ((.'hcckrwmwonly) REINFORCED PLAS71C (FRP) []10. COATED STEEL ❑5. CONCRETE TANK RUERIOR LINING ❑ 1. RUBBER LINED ❑3. EPDXYLINING GLASS LINING ❑95. XERXES 446 DATEINST LED 447 �❑y5. ORCOATING ❑2 ALKYD LINING ❑4. PHENOLIC LINING rC}y UNLINED ❑99. OTHER lCla:ckrmc irrm r Fur kiwd use aa! OTHER CORROSION 01. MANUFACTURED FIBERGLASS REINFORCED PLASTIC ❑95. XERXES 448 DATEINSTAIIED 449 PROTECTION IF APPLICABLE CATHODIC 1714. IMM2ESSEDCURRENT [:]99 OTHER - PROTECTION (0beckomHein only) ❑2 SACRIFICIAL ANODE (Far kxnfusr only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (pnr kwalusc on/y) 45l OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 SPILL CONTAINMENT TTT [:]I. ALARM ❑3. FILL.TUBE SHL70FF VALVE -- /Cheakall that apply) ❑:. DROPTUDE ❑2 BALL FLOAT 04. EXEMPT 3. STRIKER PLATE S Y� 1V. TANK LEAK DETECTION(.�dcscnpeianojrhenroniforingprogivmshallbasuhmittedlalhelacolagamyj IF SINGLE WALL TANK (CJw*aff that apply): 453 IF DOUBLE WALL TANK ORTANK WITH BLADDER (Check ore item only): 454 ❑ 1, VISUAL (EXPOSED PORTION ONLY) ❑5. MANUAL TANK GAUGING (MW) ❑ 1. VISUAL (SINGLE WAIL IN VAULT ONLY) ❑2. AUTOMATICTANKGAUGING(.aTG) ❑6. VADOSE ZONE 2 CONTWUOUSINTERSTITIAL MONITORING 03. CONTINUOUS ATG ❑7. GROUNDWATERetD-. MANTJALMONrrORTNG ❑4. STATISTICALmsNiORYRECONCILtAmoN(sm)- ❑8. TANK111MG BIENNIAL TANK T1iS TNG ❑99. OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (lEUMO•'DAY) 455 ISTLMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FB.LED WITH INERT MATERIAL? 457 V. L.. No