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MY I ILV r1\ UNDER-ROUND STORAGE TANK.`. TANK PAGE 1 Akio pages per tank) Page-of TYPE OF ACTION ® 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Dhow ons nem only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Speafy reason-Ick bcal uae aryl (Specdy...-fakcaluaeonry) ❑ 8 TANKREMOVED 4W BUSINESS NAME(Semeea FACIUTYNAMEc,O9A-Don1 ausiless Aa) FACILITY ID: I I t Unocal/Subway dba JD Singh Service Stations, 3 A /y7(o.�Z LOCATION WITHIN SITE(Optiael) 431 26485 Thornton Road, Thornton, CA I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system Including buildings and landmarks shall be submitted to-the local agency.) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes No 434 Tf! oSG3G9/ ContaimentSolutions IX'Yei,compbteonepage lasachcanpaNnant DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS ,37 6-03 12,000 two(2) ADDITIONAL DESCRIPTION(Fa cul use only) 438 This tank is a 20,000 gallon split tank with 8,000 112,000 compartments ll.TANK CONTENTS TANK USE 439 PETROLEUM TYPE uo ®1. MOTOR VEHICLE FUEL 01a. REGULAR UNLEADED [12. LEADED [15. JET FUEL (If marked canpble Pnac l Type) C§1b. PREMIUM UNLEADED [13. DIESEL [16. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑tc. MIDGRADE UNLEADED O 4. GASOHOL [199.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME prom HacaN s Matenals livor page) 441 CAS#(frau Hasardous Materials Nvenlory Pape) 442 ❑4. HAZARDOUS WASTE (7rcAAtes Used or) [195.UNKNOWN Ill.TANK CONSTRUCTION TYPE OF TANK 0 1. SINGLE WALL 3.SINGLE WALL WITH 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chea are Mem ally) EXTERIOR MEMBRANE LINER [195. UNKNOWN ®2. DOUBLE WALL [14. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-prinrytahk 1. BARESTEEL 0 3. FIBERGLASS/PLASTIC 5. CONCRETE 95. UNKNOWN 4N (Check one Mem olYy) [12. STAINLESS STEEL [14. STEEL CLAD WIFIBERGLASS ❑S. FRP COMPATIBLE W/ [199.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL1. BARE STEEL 0 3. FIBERGLASS/PLASTIC 5. CONCRETE 95. UNKNOWN (Chea ae Mem or*,) [12. STAINLESS STEEL [14.STEEL CLAD WIFIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%MEIHANOL [IS. CONCRETE [110.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED [13.EPDXY LINING ❑S.GLASS LINING ❑95.UNKNOWN 448 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑9 UNLINED ❑99 OTHER (Chock one Ilam sully) (Fa local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 44B DATE INSTALLED N9 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Chea ole Mem orgy) ❑2 SACRIFICIAL ANODE (Fw bey use only) - SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(bcal use aNy) 4 t OVERFILL PROTECTION EOUIPMENT:YEAR INSTALLED 452 mr Via) ®1 SPILL CONTAINMENT 2003 ®1 ALARM ❑3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE 2003 ®2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 2003 IV.TANK LEAK DETECTION(A&..pion or the m**wkv ploprrll"a subinMed b he local aga yj IF SINGLE WALL TANK(chock an mal aPW) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Clerk ae Mem ole,) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑e VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING e(SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456457 REMAINING TANK FILLED WITH INERT MATERIAL? gallons ❑Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B