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PROGRAM NS <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> F (two pa p- ) <br /> Page of_ <br /> TYPE OF ACTION ❑1 NEW SITE 4 AMENDED 5 CHANGE OF INFO TION ❑ 6 TEMPORARY SITE CLOSURE <br /> (Check are*m only) ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEwALPERmrr ( -forIocai ase only) ( -for to al use only) ❑ &TANK REMOVED430 <br /> BUSINESS N (Same as FACILITY NAME or DBA-Doing Business As) 3 FACII TTY ID: 1 <br /> Circle K#2705448 <br /> LOCATION WITIIIN SITE( ) 431 <br /> I.T ION (A scaled plot plan with the locafim ofthe UST system inchufing buildings and lmdmwks Mall be subnftedtothe local a cy.) <br /> TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TYes J@ No 434 <br /> 1 UNK If"Yes",oomplete onepaga for each coarpartnent <br /> DATE INSTALLED(YE O) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> 1998 10,000 <br /> ADDITIONAL DESCRIPTION(For Imal use only) 438 <br /> II.TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> I. MOTOR VEHICLE FUEL III& RE ED ❑2. LEADED ❑5. JET FUEL <br /> (9-kod cornplate 1,011,0101101Type) ❑Ib. PREmrum UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL <br /> ❑2. NON-FUEL PETROLEUM ❑1c. E UNLEADED 0 4. GASOHOL ❑99.OTHER <br /> ❑3. CHEMICAL PRODUCT COMMON N (firma Harroxions matmak In ) 441 CAS#(from� ) 442 <br /> ❑4. HAZARDOUS WASTE <br /> (IncludesUsedoil) <br /> ❑95.UNKNOWN <br /> TANK CONSTRUCTION <br /> TYPE OFT 1. SINGLE WALL 3. SINGLE WALL Wrm 0 5. smu WALL wrm INTERNALB DER sysTEm 443 <br /> (Check one item o*) EXTERIOR MEMIBRANE L [195. UNKNOWN <br /> 2. DOUBLE WALL ❑4. SIGNLE WALLIN VAULT 0 99. OTTER <br /> T MA - 1. B L C1 3. FIBERGLASS/PLASTIC 0 5. CONCRETE 95.UNKNOWN 444 <br /> (Check onedem only) 0 2. ST SSS [34. S w ER s ❑s. FRP CO LE w/Ioo*A METHANOL ❑99.OTHER <br /> REINFORCED P ) <br /> TANKMATERIAL-secondarytank E3 1. B STEEL 10 3. FIBERGLASS/PIA8171C 5. CONCRETE 13 95. UNKNOWN 445 <br /> (Ch oae*m only) ❑2. STAINLESS STEEL [34, sTEEL cLAD w ER s ❑&. FRP coNrmiE wtiom.METHANOL 0 99.OTHER <br /> REDWORCED PLA ) ❑10.COATED STEEL <br /> ❑5. CONCRETE <br /> TANK OR LR41NG 1.RUBBER LINED 0 3.EPDXY L24ING 0 5.GLASS LWING 0 95.UNKNOWN 446 DATE INSTALLED 447 <br /> OR COATING ❑2 ALKYD LDUNG ❑4 PHENOLIC LINING 6 UNLINED ❑99 OTHER <br /> (Check one i m only) (For local use only) <br /> OTHERCORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REMORCEDPLASTIC 0 95 UNKNOWN <br /> 44 448 <br /> PROTECTION IF APPLICABLE PROTECTION ❑4 INIPRESSED CURRENT 0 99 OTHER <br /> (Check one ftm only) ❑2 SACRIFICIAL ANODE (For local use only) <br /> SPILL AND OVERFILL YEAR INSTALLED 450 TyPE(tow use Y) 451 OVERFILL PROTECTION EQ INSTAL 452 <br /> (Chock au 0-wly) N'SP'LLCONTAR&1ENT 2003 IN 1 ALARM 1998 ❑3 FILL TUBE SHUT OFF VALVE <br /> 2 DROP TUBE 2003 1@ 2 BALL FLOAT 2003 ❑4 EXEMPT <br /> 3 STRIKER PLATE 1998 <br /> IV.TANK LEAK DETECTION(A deemphomofthemonaomogymmoma aw be sabrofted m ) <br /> IF SINGLE WALL TANK(checkathat ) 453 IF DOUBLE WALL TANK OR TANK Wrnf BLADDER 454 <br /> (Checkoceitam only) <br /> ❑1 VISUAL(EXPOSED PORTION ONLY) ❑s MANUALT GAU G G) 0 1 vmuAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE 9 2 CONTINUOUS mmsITITAL MONITORING <br /> ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑S T TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTHER <br /> IV.TANK CLOSURE INFORMATION f PERMANENT CLOSURE IN PIACE <br /> ESTINIATED DATE LAST USED O/DAY) 455 ES TED QUANTITY OF SUBSTANCE$ G FILLED WITH INERT ? 451 <br /> gallons 0 Yes 0 No <br />