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I INIFIED PROGRAM CONSOLIDATED FOAM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page-of_ TYPE OF ACTION ®1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Chetic ane from only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specityreason-forlocalusionly) (specify reason-for kcal use only) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Some as FACILITY NAME or DBA-Doing Business As) 3 FACILITYID: t Unocal/Subway dba JD Singh Service Stations, LOCATION WITHIN SITE(Optional) 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 Contaiment Solutions If'Yes',oomplea one page for each umpahm ,t DATE INSTALLED(YEAR/MO) 4- TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 6-03 12,000 two(2) ADDITIONAL DESCRIPTION(For weal use only) 438 This tank is a 20,000 gallon split tank with 8,000/ 12,000 compartments IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 7 440 ®t. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED 2, LEADED Cy- ❑5. JET FUEL (If marked complete Petroleum Type) 01b. PREMIUM UNLEADED 3. DIESEL [16. AVIATION FUEL [12. NON-FUEL PETROLEUM ❑10, MIDGRADE UNLEADED ❑4. GASOHOL [199.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (frorn Hazardous Materiels Inventory page) :78 rdous Materiels Imrsmorypege) 442 E]4. HAZARDOUS WASTE (Includes Used Oil) [195.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3.SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item ony) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 02. DOUBLE WALL [14. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank 1. BARE STEEL 03. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/ [199.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secondarytank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC [15. CONCRETE [195. UNKNOWN 445 (Check one nem only) [12. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑B. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL [15. CONCRETE [110.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING [15.GLASS LINING ❑95.UNKNOWN 496 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑e UNLINED ❑99 OTHER (Check one item only) (For local use only) OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For kcal use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENTNEAR INSTALLED 452 (Check all ®1 SPILL CONTAINMENT 2003 that apply) ®1 ALARM ❑3 FILL TUBE SHUT OFF VALVE (9 2 DROP TUBE 2003 ®2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 2003 IV.TANK LEAK DETECTION(A description of Ne monitoring program shell be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 45a (Check one nem only) ❑1 VISUAL(EXPOSED PORTION 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 +(SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LIST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 REMAINING gallons [-]Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B