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.r Tank 2 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one Tann Per UST) TVPF.OF ACTION (('heck one item only. Foran I'ST permanent cloture ar lentlival,complete only this section and Secliam L 11.111.IV,and I%helm{ ❑ I ;NF.WPLRMIT ❑ 1 It P:NI'.WALNRMI'T ® 5 VIIANOE I IF INF ORMA 1101; h.TEMPORARY UST C LOSURG 7.UST PIRhIANE\'f cLOSIRE ON srw K.LIST REhIOVSLL DA'IF:LIST PhRMANLNIIA (LUSIiU: I)o' I DA I F.FXISI ING US 1"IIIS('OVI-RI-D: 11i4 1. FACILITY INFORMATION FACILITY ID N I:Igv&% f6.On/1) I BUSINESS NAML(Sal us FAC'ILI rY NAME oI DBA-Doing BNainess As) Costco Gasoline (Loc.No.658) UUSINESSSIIL ADDRESS In, C'lly 1.4 3250 West Grant Line Road TreeIt II.TANK DESCRIPTION TASK It)h 112 TANK MANUFACTURPR 1" IANKL'ONFIIIIIRAl10N. IJu51dNKIN I.A h1 ANO-Al 2 Containment Solutions ❑2.UNI t\A:\I. ON' LANK tel\IP:\R[\ILNIF.n tP'll. ten+.-Iw.el.n:4:on.:�d„nmrnm nlNe men DA I'I(USI SYS I'hMINSTALLED J)s "TANK C\PAC'ITY•IN GALLONS i"• NL K1131 R 01'OMPAR'rmwis IN I'HF.UNIT 9/11 120,000 1 1 111.TANK USE AND CONTENTS "TANK USP IN U MOIOR Vi Ill('I L Ft FI IND ❑ Ih MARINA I Fl INIi ❑ Ir AV'IAT'ION FOFI ING +" ❑ 1 ('ell'\11(41 PIIODUL"T STORAGE' (3 J IIA%:\It)OUS N',1NTI(%lu.b)..U..aOio ❑ s.FNII7ttiFNCY(3FNLItATORFIIFl Ills'e`s2lisiol C1 I.OTlIFR ORNERATOR FUEL ❑ '+' UNKNOWN ❑ V'I,(yr11Eft ISlw6i)1: CONTENTS PLA ROI It Vil 10 la RL-6ULAKI.VILAOID ❑ In NIID(MADI.I,NI L-AOFD 11, PKL•MII;SI 1.'NI UA)FI) 10 ❑ ).DII:SFL ❑ SAFT I C11 ❑ n,:\YIATIONGAS Q N,PI•TRO(FC\I til FNO Fl IFl ❑ ll.01 OFR rVI ROI FtAf (S N.tKI: N"(77TROIF.I:NI 7,USF1)01] I-II+I'IIANOI 71 11.OTIIE1it NON-PETRO CAIS of : uun IV. TANK CONSTRUCTION I YPF OF IANK ❑ 1 SIN61 P.NAZI [1) J.0011111 F11 AI l 451'NKN01\N ul PR I MA RVCON I At NNI LN f 1.51118 • I.FIRtR(;,7N go LI:I N I II IV 4l R IA I II I K iu ❑ %.S1 1 L INTIANALLINING ❑ V5 U.NKN6N'N ❑ 00.0711LR IS eibl "l'+ Sli(NIJARN('01,11AINMEN1 cl Iti1h.IlI 1]11In1•Kfil ANl ❑ hl\IF.ILI)N\II MInNANIIINIK ?JAC KL 111) Ili NONb 45,UNKNOWNVVH 1)AT(1111FR IS 1,IPO OVFRI Ili PRI-VI NNON L At IOINI f k\'IFD.AI At.ARMS !.14A1 l i FILL wine Sime-OIL VAl Vf - ❑ J,TANK M LEI S RE OIREMEWS FOR EXEMPTION FROM OVERFILL PREVENTION EOUIVMEN'I" V. PRODUCT I WASTE PIPING CONSTRUCTION PIPING COVSTRCCT ION 0 1,SINGLF-WALLED 2DOE"[it E:\Y:\I LFD 'roe OTIIFR A"• S\'SI LAI TI PL 1111.PRLNSVRL '' O .6kAVll'1' 1.l'(INV'LKT IONALSVCIION J SAFLSU(-1ION[21t1xi=hewa'; + I" PIRIMAR\'('ONFAINNIPNI I YI FPI 1 FII4FRUI ASS M FI FIIILII 111 KIIIIO Ill A l,I'I l' u'I ❑ VI).,\ON[ p 'b.11NAN(1\\'N ❑ Y'I.I I I I II R(5nnh1 SLC ONDARY CONTAI NM EN I ❑ I.SI I-.E I. ❑ J.19 Bt RGLASS M S.It IAIBIA Ll In MOLD PLA,IIL men 9,LXDN'E ❑ VS.UNKNOWN ❑ v".U I I I LR(SINcI I)r PIPINWI IIRNIVE CONI AINN117N ISI INI V 1)-1'F • 1.)IN(;I F WAI I. Q '.00l1Ktl:IVALI- wNO\F 4n4n VI.VENT.VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY('ONI\INNIFNI 1.S'1'fE1 • 1,1-111110.) \55 ❑ nKIGIDPI:\i I It NI NONE u9 011IPN 1Spr.IF1 +u+. v.+.I VF N1 SLUONPARY f'ONJAINNII'NI 0 I.sItI:I R 41'In 8111 ASY C] It, R161)Ill WIt 'ha NONI 0 un 0111h R1FpwIla, J4,11 "I'll \'K PRIMARY ITa51.VINMI:N1 I.51191 • J 1 R(1I 0 IU RUM)Ill ASI II 0 VII NONi 'al 0I114 R lNiw4'131 POO 1k l•1 \'RiNONDAIVYCO,' A LS7'I:1:1 J.1 IBERIA,\SS 0 IP RIUID Ill ASTM 0 90.NON[ Ll 99.OTIILR1SPe:i)1 4141 m 11., VLNT 1.SLGLI,WALL _,WRIBL(\\'AL1. M 9n,NU 1'. Ino RISI'R PRIMAR1 l ON I.AINMI N I • LSI I.III U 4.1 110 Kid ASS HU In Rllilm-LAS II( U u.-N(lNlU V9 OIIII.N 6pea Hy 4w, J."1 RISER SU ONDARY CONT:\1NNIF:NT 0 15TELL 0 J.1'115LIU ASS 0 In 11161D PI.Ail It IN no.NONI El 94 OTIIIA ISryuNl 11•n I'M Fitt.COMPON&NTS IMSTAT 11:5 1.S I-. SUL'KIT • ..STRIKIA PLATE:13OFTONI PROTFC TOR INJ, ,\] SINtr1<1. VII.UNDFR DISPENSER CONTAINMENT(UDC) (ONSIll TION I)PF Q 1.MWI I+11 All ❑ ' 18)(2141 F.\C ill ❑ 4_N011151'FNSIRS ❑ 'nl Nov (ONSTRI,rRIN\IATEKIAL ❑ I.STEIN. tj 1,FITAkill ASS N lu RItill)P.ASTI(' ❑ nn,tlfllf:R(A,,l,l m'm. VIII. CORROSION PROTECTION SI'N:I.COMPONLVI I'K(r1ECIIOK p '. SA(-NIFII'l:\I ANOONS1 ❑ 1 IW'RI'SSM I•('Rill N 1 ❑• I, ICOI NIIIIY - IX. APPLICANTSIGN ATURE C PXIIFICAT ION: 1 O rtlf�that this I,N'1 s\stem is compatible Nith the ha(ardnus substance Bored and that the informaliau peal,lded herttilris true,ocrurnr. and in full Coro Mance aidIfIrtt.1 n•1 oiremenn, APPLICANT STUN Pi Il':\S"f.\A\If 1prinU I I M'I'LK ANI I TLE (- David H Roe Director of Real Estate Devel men (PCFIIS'1'-R-112 Res.(ISr2 )