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V-\ T KS UNDE�3ROUND STORAGE TANK£1 TANK PAGE 1 C\\�\�� j#/ (two pages per tank) Page_of_ TYPE OF ACTION ® 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Choc ane gem m0y) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Spadtyraaem-Ict c useonly) (Spedfyreasm-fc locelusemly) ❑ 8 TANK REMOVED Oe BUSINESS NAME(s.m.as FACIL r NAME or DBA-o k Bushgess MI FACILITY ID: 1 Unocal/Subway dba JD Singh Service Stations, 3 �F}/f7lo2, LOCATION WITHIN SITE(Optional) 431 26485 Thornton Road, Thornton, CA 1.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 t33 COMPARTMENTALIZED TANK Yes Na 434 1 T DS/S 1e 89 Contaiment Solutions X'Ysi,complete ane pope ion each canpanmerg DATE INSTALLED(YEAR/MO) 4 s TANK CAPACITY IN GALLONS 438 NUMBER OF COMPARTMENTS 43] 6-03 20.000 ADDITIONAL DESCRIPTION(For b l use my) 4M If.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ® 440 1. MOTOR VEHICLE FUEL ®1a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (M corked cemplNe Po"lwm Type) ❑1b. PREMIUM UNLEADED [13. DIESEL ❑6. AVIATION FUEL [12. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER_ (:13. CHEMICAL PRODUCT COMMON NAME (from Haze 3 Materials k cxy page) 441 CAS#(tram Hac.N .Materials Imantary pope) 442 [14. HAZARDOUS WASTE (Mrluges Used oil) ❑95.UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL 3.SINGLE WALL WITH S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chock sage Irm mho EXTERIOR MEMBRANE LINER [195. UNKNOWN 19 2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER_ TANK MATERIAL-Primary to* 1. BARE STEEL 0 3. FIBERGLASS/PLASTIC -ET-6.-CONCRETE 95. UNKNOWN 444 (Check cage Ilam only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERULL-eaoagayteA E3 1. BARE STEEL M 3. FIBERGLASS/PLASTIC5. CONCRETE 95. UNKNOWN 445 (Chock ane Ysm only) ❑2. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE [110.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑e UNLINED ❑99 OTHER (Chock are,Mnl only) (Far 1041 use orgy) OTHER CORROSION ❑1 MANUFACTURED CATHODIC®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Chock one Yom only) ❑2 SACRIFICIAL ANODE (Far low uas aM') SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local uss only) 1 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (ChocitX1) IM 1 SPILL CONTAINMENT 2003 that OPOY ®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 IA desorption of age m"AmYp p ugrrn"bs-ekdniped b pe,local pmaY.) IF SINGLE WA (check en LL TANK(chethr appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check aro Yam only) ❑1 VISUAL(EXPOSED PORTON ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING t(SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YRM10/DA`O 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 REMAINING gallons ❑Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B