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Tank 3 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK IIF NFORMATION FOnr farm rUsT) TYPE OF ACTION ICheck o.Imn1 only. For an UST permanent closure or remnl'al,complcle null this section and Section$L IL III,IV.and IN W.o%') ' ❑ I NF.N'mitrol1, ❑ 1.RENLWAL PERN111' Q S.VIIAN'GI'.OF INFORMATION G.TEMPORARY'UST('LOSURF. 7.UST PERMANENT CLOSURE ON srry K UST RIiMOVAL DA I FUST I'ERMANI-.N ELV("I.OSEA): 4"" DATE 4\151 ING LS IDISCOVER F D: � I. FACILITY INFORMATION FACILITY ID R 1.I}rn,r I'Je 01119 BUSINESS NAME(Saner as FACILITY NAME or DBA-Doing umirrm As) Costco Gasoline(Loc.No.655) DUSINLSS SII L ADDRLSS In CITY 3250 West Grant Line Road Trac 11.TANK DESCRIPTION 'I'AN'K 11)k 11' FANK MANOFA(TURER I'll I ANK rnRHra lR AnfN. 'rues TANK K Q I, \N I ANI I-:\I DNI 1 A\K 3 Containment Solutions p 2.OSI IN A tOMP.ARI MENDED LIKu. DATE usT SYS1 EM v4s rALLI9D ) TANK CAPA(TFY IN GALLONS +'I• NUNIRI!K OI�C'OMPAR"I'kIRN1S IN 1111'.UNH' +" 9/7611002 20.000 t 111.TANK USE AND CONTENTS 'TANK USE IN la MOIOR CFI11111,F'IIFI ING Q IF, MARINA H I LINO Ic AVIAI'IONFUFLING O° Q 3.111FMICAL PIEODLiC rSIORAUF Q +,1 L\ZARDOOS WASTFO.,['J,L-d Olh ❑ i.FNIFROF:NCYOF.NFRATORIVELplsl'v?:+1?L4 Q n-OTILRUNE9UNKNOWN °°' PFN I1 ❑CONT[N75 le RLOIA AR I:NLI:AOeO Q 1° MIIRi(ADLLNLh.A111:11) f] Ih PNI:MIPN11'NLE:1OFIl uo ❑ :.I)ILSFL Q SIFTFUEL Q h.AVIATION W9 Q R.PFIROI 1`01111 END FCPI ❑ 9,OtI1FR PI'dROI FUM 0i •Plfr, 111i NON-1FIRl1111IND ] l!NFU fell 111 IANUI I1.0r11ER NON-PETROLLI'M ciio,oh: -0 IV. TANK CONSTRUCTION 7\'1•F.IIF TANK I.SIN61 F 1%A[l I] =IRmHI F\\':\I 1 Troi.tINKN( N I l' PRIMARYCONI'AINmENT 1.SIFFI • F.FINFRULAti R,INffk.N'AI NI AODFK IU 7.STEEL INTI'RNAL LINING ❑ 45.DNKNO\\'N Q 920TI IRR IS .ciPoP 111'' MCONUAIINCONIAINNIP.N'I I.11 F.-II I!1) 1 IRI•RLIASS a.fCl{k 11)R\II NII)R.\\'I'.LINL.K ] IA(Kb:lPl) I1' 42.NVNF 'S.ILV KNUII'N 44.OI'HFH IS,rcII\1. Ovmm I PREVENTION 1,AI DINE F k VIN191 A A \ti 1 fiAl fl OAT i.FIL1.TIIIf{'Sllllf-OPF VA ❑ 11 ANK MEET S RE LrIREMEN ES I'OR EXEMPTION FROM OVERFILL PREVHNFION F. UIPNCNT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPINKI CONSTRUCTION 0 I.SINULE-W'ALLFD 1_.1)DLU-1':\\'ALLFO 99,OTHER SYSTEM TYPE LPRIiN5FIRE ❑ 2URAVITY Q )-('ONVENTIONALSUCHON i.S,VCSVCIIO\ oleo;lbtk4')� 1`" PRIMARY CONTAIN1,11 N 1 114:1'1 -1 "HI- UI ASS K.FI PXIH.1 In ROOM PI.ASTI(' In+ Q 411.NON1-. Q 9N.(INKNIIAA'N 911,OI111 KIS •'o' . mt' Sl(ONU,\RY t'ONTAINMIiN I' Q I-SIF1'.1. QJ.FIDL.RUL:\sS N,FLEXInLL ❑ 111 RIGlD PLASTIC 1nm 411.NONE ❑ 45.UNR WW'N ❑ 44,OfMER IS ccniH. °.'. I'IPIKUI'LIHNINEI'ONIAINM IiN1 SISND'IN III, I NIN " W:\LI. 2.1R)tINLF)\'AU. '111 VUNP '�1 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION YIN[ PRIMARYCONI'.AMN'i F.NI' Lj ISO'Fl 91 1.FIHI:R61 ASS Li In RIGIIII'I.ASIK C1 911,NONE LI 49 p1'HF R!S(nedli 41.4 +Mrl \'I N I NO CINDARY('ON LNNMFN I' QI "Im IN 41 Ed RGI.155 lu RIgHPLAUR' 0 411 NONE 0 'A OIIIIIR ISPe-blJ1'1 +nm vR 'RIMAINCONI'AINNI 1,11 0 ISIF1 1fIHFRGIASS 0 III RIGID I'1 ASTM Ll 41) MINE U -1-1 OTHER ISpea(yl 1'•IP udd 4R Sid ONDAKY CONTAINNIENT 0 I.STLLL M 4.Flaf. (i ASS 0 IP FOR PLASTIC 0 911.NONE 99.OT1 11711 ISprai l l J 1NLI \'ENT PIPIN(1 TRANSITION 5 tP TYPE I.S)NGLI-WALL 2.DOUBLE WAI-L911.NONE 1611 R IRI-R PRIMARY FON FAI•NMI N I I.511'.1'.1 U 41lot RGI.\NN •Ill RIGIOI•IASIR ha.NONF U 'J'JOIIILKINNOIF) I''4 46hi RISI.R SI.I ON DAR\'('ORT,\INNIEKT 1.WELL 0 4A lilt RliI INS Ll IU RIGID PI ASTR M 9n.NONF. U 49,(011117 lsr zlO)l ml1 Irvlkl FILI L'0.%fP . S "y-A '1 • I.SPILLFFULKIT • I.STRIKF'R PLAIFROTT01,11,117-177'row jo 4XONTURNIFINTSUNIP 111.7 VII.UNDER DISPENSER CONTAINMENT(UDC) (ONNIRI(DON nl•F. 901.S1NGI F N4:M 1 Q 2IX'tRI r.W'ni I QI.NO DIMNNSFRN 0411.NONE +' CONSTRI'C'TION N1ATLkIA1- 1-NTEQ Q 4.FI0FRGIA55 M to HIGID PLASTIC U 99,0TIILRIS 'uI I VIII. CORROSION PROTECTION T SIH-I COMPONhNI PROEVIION Q .7.SACKIFICIAI :\\UOI:ISn ❑ J INII'Rh SSFD I'1 RREVI IE e,ISOLATION IX. APPLICANT SIGNATURE CEH'1'I1FICA'1ION: 1 carol)Asa Ihis 1 N'1 spston Is emnpalihle With the haJwilous suhslance Blared and(hat the inrm•madon provided herdn is true.arruiale, and In full rum lion with Ir'al n• alrnnrnl). APYLICAry,T.SI r\ :\I'PLII'A\"f N:\\ - )aunt 1 I APPLICANT I'f[.E. L David H Roes Direclor of Real Estale Devel ent T PCF UST-R-1!2 Rv\.(12211417)