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LIVIED PROGRAM CONSOLIDATED FORqP TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 ry, (two pages per tank) �QJ - Page_of, TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED P MIT 0 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-for local use only} (Specify reason-for local use only) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Same asFACILITY NAME orDBA-Doing'BusinessAs) FACILITY ID: Wool 7-Eleven #17847 3 d t LOCATION WITHIN SITE(Optional) 431 1048 W Yosemite, Mante TAtIK) I SCRIP salad ilk#€ars v t f#t4Ic1G�i#f�iI �t#tie U��Inch#t€€ng�r#lditt��et�i lam �r sL1#tt�tltied .xi_ :..... TANK ID 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 rD,5-0 Xerxes If"Yes",complete one page for each compartment. � ATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1211998 10,000 ADDITIONAL DESCRIPTION (For local use only) 436 €I4ARil�r�53FlISIT ' -- ...:....... ... ... ...:,... :.. . .. NK USE 439 PETROLEUM TYPE 440 R VEHICLE FUEL ❑1a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If marked complete leum Type) 0 15, PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION ❑2. NOWFUEL PETROLEUM ❑10, MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER COMMON NAME (from Hazardous Materials Inventory page) ❑3. CHEMICAL PRODUCT 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE Gasoline (lncl'udes Used Oil) [195,UNKNOWN fes, _. ,r II# T'AA#K�OIUSTRIIC"�#t33t1' ; ;TtE ANK ❑ 1. SINGLE WALL ❑3.SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 one item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 0 2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank [11. BARESTEEL 0 3. FIBERGLASS IPLASTIC 5. CONCRETE Li 95.. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD WIFIBERGLASS ❑8. FRP COMPATIBLE W1 ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK RIAL-secmndarylank ❑1. BARE STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE ❑95. UNKNOWN 445 (Check one item only) [12. STAINLESS STEEL ❑4.STEEL CLAD WIFIBERGLASS [18. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE ❑10.COATED STEEL TANK INTERIOR LINING 0 1.RUBBER LINED ❑3.EPDXY LIN GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (Check one item only) (For local use only) 446 DATEINSTALLED 449 OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Cheek one item only) El SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use on 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all ® 1 SPILL CONTAINMENT 1998 ®1 ALARM ®3 FILL TUBE SHUT OFF VALVE that apply) 2 DROP TUBE 1998 ❑2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 1998 ;.#u TAfiSIKlklfT 1F{A, esctpaol, S4n�rs�n�irtrana R! ritr+aEl he sofas n ti tozhc lccxil>ag�fiaY j 454 IF SINGLE WALL TANK(Check all that apply) as3 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) 016 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG 0 7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑B TANK TESTING +(SIR) BIENNIAL TANK TESTING ❑99 OTHER _- TV.—Ti4[ WCL II%fl~ R#�IR N 1 f21�Eli CtikT CLflS lEtE CISALAI�Iw a55 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 ESTIMATED DATE LAST USED(YRIMO/DAY} REMAINING gallons ❑ Yes ❑ No