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.� led Tank 1 UNIFIED PROGRAM CONSOIADATFD FORM CNDERGROUNDSTORAGF.TANK OPERATING PERMIT APPLICATION-TANK INFORMATION lone ratln 'rUST) TYPI'.OF A('TION (Cherie ane item only. For an UST p.'rmonenl cinsure or mnuIval,complete only This section and Seclians L IL 111,IV.and IIN Im1o111 "' ❑ I NEW PFRMII' ❑ }.RENIL\ASNL PFRMI If] S ('IIANUE.OF INFORMAHON b.TEMPORARY UST CLOSURE 7.UST PERM AMEN I C'LOSU'RE ON SITE N USTRP.MOVAL OAIF.US 11'I-.RAIANF9N rd.Y('IASLD: 1"' I I IA I E I XIS I IN( IA I OISCOV'I RH): 1. FACILITY INFORMATION FACILITY Irl d 1.Igo),t l8o 0.11'1 BUSINESS NAME(Same as FACILITY NAME al DBA-Doing Business Asl Costco Gasoline(Loc.No.858) BUSINLSSSI I L ADDRESS 1111 ('try 3250 West Grant Line Road ITracy 11.TANK DESCRIPTION 'I ASK IU II 1" IANKMANUFA(TLRER IANKITNHaIVR\IIUN. I1111I:ANKH @ I.:\>IAND-\I UNI I N\K 1 Containment Solutions ❑2uvh IN nIGMr:\a1 n(IN D-.Dour. '.:-,AI. ...r...I.0 DATE urr SYSTEM INSTALLED Jls 1'.ANK CAPACITY IN OALI.ONS -0- NUMBER 01'C•OMPAR'rMI:N'IS IN'1"IIF UNIT +` 9116MO2 120,DOO 1 Ill.TANK USE AND CONTENTS 'rANK LISP f] In MOIOII\TNICIF FUEI INO ❑ IF MARINA H T•.1 ING ❑ Ir AVIAI'IONFIIFLINO +" ❑ ) ('111'MR-:11.PRODUCT STORAUF ❑ J ❑ 5.FNfERGFNC)'GF"NFRATOR FVFL I IIS(';)5_• I&..I ❑ N.OIIit'RGENERATORFUEL ❑ 45 UNKNOWN ❑ 44.0TI(ER(SNe IID. CONTENTS PHROI HAI III In RI OM All I Nf EMIL O El I, N1IIHI11:NOF OVI I-11141) ❑ IF, I'MAIRIM INI LAIR 11 1111 ❑ 1.DIESEL ❑ i.11711:1'1. ❑ n.AVINDON UAS OR.PETROIFI:\1Ill FNDI( I1 ❑ 1)OIIIERPIIROIFIAT N""I'v NON-PFTROI EIIAF0 1.USF )011 In IIIIANOI I L OTI IER NONITE I ROLU 1l'+P OO 1. 0'^ IV. TANK CONSTRUCTION I YPROF TANK ❑ L SINGI F WAI I © 1.DER11H F U+M I 45,I:NR\O\4'N PRIMANYCONGMNAILNI LSILEI. i,FIR4RIIIA SS o.INll'I<\AL NL\UDhR ' ❑ 1.STLL:L• IMERNAL LINING ❑ 45 UNKNOWN ❑ 44 Will ISpcll"Y I: A(LVDAkN CON IAINNII NI Ej I.sit):[ Q i 11111•Rol_Am h I N I I.RIOR MI NIIIRA\I I INI K 0 / IM KI IID 40.NONE 0 45 IINKNUW' O\TROT I I'RI VF:Nru)4 I.At 1111111 F N A I INI'At At ARMS U i,Flit,11IRF Nilil l-OI'r VAI\'4 - ❑ 41-`TANK 4IEF'IS REOILRENIENIS FOR EXEMPTION FROM OVERFILL PRE%LN.-r ON EOI'IPAIEN"I" V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRL:CTION 0 I.SINGLE-\\:V-I FD M T 1X1CR1 F:W'.NI.1 Fn EI 114,01IIFR 41.. ,M STEM IN IT I9 L1'REbstlRli _',tilIAYITI' 1.l'(IS\'LN f1O\:\L S111-TION J.SAIL MY IION ; K))4 N.,I I" PRIMARY t'1IV LAINMI•Vr SIFF1 J 1.18E kill Alis • N.II F:SIHI4 In RIUIb I'I \STif ud El ".I.NONI O ntl UNKNtmN ❑ 0",UIIII KIN erl Pot' IOJ' SEL ONPARY CONI:MNNIENI ❑ LSIP.IiL ❑ J.I'IULRGIA55 [E f.fl.E:.NLIA 0 la RIGID I'LASIR I^n. 4n.NONE. ❑ 45.UNknovNN ❑ 44,0"IIIF:R(Svc11NI: �•. I'll'INUq I'RLfINf CON)AINMENr SI!M1I I•I A'Pt IN I.SINOI-F\1':\I I, 1.DOLIHI LWAY L -n \ONE 4t4' Vl.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VFN'I PRIMARY co m rAINMFN I- ISIf:FI. a t11H1 Hid ASS L1 IP HIM)N AS 111. U 'In.NON4 0 44 OIIILR Spr.11\I +"^ l \'F NI SLIONIPARN CONI:\INNIFNI' IFIIIEI IN 4IHI Wit ASS In RIGID PIAN IR 0 'in NONE. 0 4401111.1(1 Sped''' 1111 Je,u1 \'R I-RINIARV I ONFAINKII-NI 0 1 Sl11- a J,I ILL ROI ASS I IIItIOID I.1 AS I U Lj 'nl NONE 0 "4 onlFR ISP<uO1 I.••= Ini-I VRSE('ONOALLY CONTAINRII-Nt 1-Sri 1 El- N J.FIDEROI ASS 0 IV KJOIL)PIANHE U 49.NOL U 44.CITIlFR'SI ,1hI J,.0 iMW VENI PIPING TRANSITION SUMP FYPC I.SII a.l:WALL _ R)1'll L\N\LI. • 4u NONI, Ino RIM:R I'RIMAK N(ON I AINMI'NI 1SII El 4.1 1111 K4 it ASS Y) RuilDITA\111 U '..I NONI Lj 44 (11111:11 {AIl RISI:R SI COND:YRY CONT MNME:N1' 1%TIIEL EI J.F181i R18.ASS 0 la Il1O11)PI-Aiflt W 4a NONI U 44(Tr11ER'tip,afil ILa n•Ikl OIL LONIPONIFNISYNSTAIL UTI • 1,5POI NUILKITT M 3.Sit KI'R N %TE n ' 'NIPI4OTF LTOR W 4XONTAINAII'71.77II' Vll.UNDER DISPENSER CONTAINMENT(UDC) CnNSIRIW I ON INK OO 1.SINUI F\\:M 1 U _ rot ril I\\'AI 1 ❑ s SO TIMM NSI R, ❑ "a Nom LONSTRV('TION\1AFEItIA1. ❑ 1,5TI:I:L Lj J•IIU1EIRUAS-S M IO RIO H)I'LAS IIf ❑ n4.Oriul IS';;i(v In••F. Vlll. CORROSION PROTECTION SILLI CONLIONI N11'RO'I CIION ❑ SACRIIYCIAL ANOM ISI ❑ I INII'RF Sib 1)O NREM Q a 101:%I ION '- IX. APPLICANT SIGNATURE, ('ER'E IF I(':\'I ION: 1 .Iily that this IN I syslval is enmpatihlr nith the halal dous suhnmlev shred and that the inrm inalinn Ill nvided herein is Vuc, a.ru,A, and in full colo slianry h]veal ryl piremgnh. APPLICANT,' N U -s s :YPI'1.1(':\N"I. :1 All'Ipnnp 'I :M'PLICAN" TI'rLF David H Rogers Director of Real Estate Devel n Lr('F USI-R-1:2 Rn.(I7/HNI7)