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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 (Chock one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-for local use only) (Spscifyreeson-forkrelusecnly) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID: 1 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',complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS 437 6-03 1 8,000 two (2) ADDITIONAL DESCRIPTION(For krcai use only) 438 This tank is a 20,000 gallon split tank with 8,000/ 12,000 compartments II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL ❑IS. REGULAR UNLEADED [12. LEADED ❑S. JET FUEL (If marked complete petroleum Type) ❑1b. PREMIUM UNLEADED ®3. DIESEL S. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (ham Hwercmis Materiels Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE (Includes Used Oil) ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL [13.SINGLE WALL WITH [:15 SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 02. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC 05. CONCRETE ❑95. UNKNOWN 444 (Chad one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secoodaylsnk ❑1. BARE STEEL 03. FIBERGLASS/PLASTIC ❑5. CONCRETE [3 95. UNKNOWN 445 (Cheri one fern only) [12. 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 [13.EPDXY LINING ❑5.GLASS LINING [195.UNKNOWN DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑e UNLINED ❑99 OTHER (Cheri one item only) (For coal use only) OTHER CORROSION ❑i 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 (Forloraluseanly) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local ussi 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all ®1 SPILL CONTAINMENT 2003 Mat appy) ®1 ALARM ❑3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE 2003 ®2 BALL FLOAT ❑4 EXEMPT M 3 STRIKER PLATE 2003 IV.TANK LEAK DETECTION(A description of gra monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check ane item 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 09 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAV) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 REMAINING gallons []Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B