BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

Tarr 4 UNIFIED PROGRAM CONSOLIDATED FORM II 2 YL �` 'aUNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFOR- N(One form per UST) TYPE.OF ACTION (Check one item only. For an I'ST Permanent closure or removal,complete only this section and Sections I.11. ',and IN ') 1w ❑ I.NEW PERMIT ❑ I.RENEWAL PERMIT IN 5.CIIANGE OF I R TION (0)9-5-Ayr3 El 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE K.UST REMOV DATE UST PERMANENTLY CLOSED: "'` I DAI F I XIS I ING US I DISC'OVERF D: ulx. 1. FACILITY INFORMATION FACILITY'IDN 1.4gnel I'sr(hthl _ - r BUSII\I N\ \.\\IE(Sam,as FACILIT)'NAME or DBA-Doing Business As) 1 �j D �` 7 Q Q 1 ' Costco Gasoline (Loc. No.656) I 1` d G (J U - BL'SINLSS 5111 %DDR[SS I' CITY Ira 3250 West Grant Line Road i Tracy 11.TANK DESCRIPTION TANK 11)# "' I`\\K \1.\\UP\CTI RF.R 1'1 1 ASK CONFIGURA'rioN. THIS TANK IS 1O TAoS/Io ®I AST ANTI-AI ONE TANK Containment Solutions 0O0(( ❑? ONEIS A('011PARTMFNTED UNIT. [:.mpla,ld.•m Ca,e bn exfi _ DATE US T -Y'TTh INALLED 1' 1 A\K C APAC1l'Y IN(141.1 OSS 11^ Nt.MBBR OI'C•OMPARTMI'.NT'S IN THE UNIT 1" TBD ST1.500 1 1 111.TANK USE AND CONTENTS 'LANK I'SP ❑ la MOTOR VEHICLE Fl.4I 1\(I ❑ to MARINA Ft "ING ❑ Ir .AVIATION FUELING 419 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.IIGZ,\RDOUS33.ASTFWLGJ.,I'uJOiII ❑ 5,FMFRGF.NCYGFNFRATORFUF.LIHSCOal5:919u1 ❑ 6.OTHER GENERATOR FUEL ❑ 95 UNKNOWN 91 W.OTHER (S Nf I: Fuel Addilive H9+ CONTENTS Piil ROL EI:\1. ❑ la IAR111,6ARt NI LAUD ❑ Ic MIIIGRADF I Ni I-:ND41) ❑ 1 PREMII IM INI FAIN 1) H^ ❑ 3.DIESEL ❑ 5.LET RTL ❑ n..AVIATION GAS ❑ N.PETRO[FLM HINO FUFI ® 9.OTHER PFTROI Ft \1 (S ,.KI Fuel Addithis 141' NON-PFTROI.F.I:M:E3 7.USFD OII. 11).ETHANCH IL OTHEASION PMOLEL McSocoN, aRro IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGIT AAtI IN 2.D01 In F q'A1.1, 95.I1NKNOWN 1H PMIM.ARY CONTAINMEN"1' 1.STEEL 3,FI BF RCM LASS 6.INTERNAL BLADDER H4 ❑ 7.STEEL • INTLR\AL LINING ❑ 95.UNKNOWN ❑ 99.OTIIER (S •,ilvl: H1u SI CONDARY CONTAINNIh NI 0 L Sf F.FI. Iii 3.HRERGI.ASS ❑ fiA-XTF.RIOR MI'MRRANF I-INFR ❑ 7 JACKI.111) HS 90.NONF ❑ 95.IINKN)W'N 99.(/TH-FR S " "S. OVFRFII I PRFVFNTION I.AI!DIHI F R VISUAI.ALARMS :.HAI 1.FI O.AT 3.FH.L TI03F SIIUT-OFF VALVF "I ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION I-SINGLE.-WALLED _l)OUBLEW:ALLCU 099.OTHFR 4^9 SYSTEM TYPE f6 I.PEESSGRE ).LJEAI ITl' 3.CONVENTIONAL SUCTION [14.SAFE SUCTION n It R Ue\m+ab 4s. PRIMARY CONTAINMFN F L .TFFI i.FlHFRGI•\SS x.FI.FXIHLF ❑ 10 RICAO PI.ASTH, 'Is1 ❑ NI.NONI. ❑ 95.IINKNIIW'N 99.01HFR 5 nf'f '1 SLCONDARY CON LAI\MF NT O I.STELL O 1,1'IBLR6L\SS 0 a.FLEXIBLE O to RIGID PLASTIC' IMF 041.NONE ❑ 'E.1'NKNO%kN ❑ 99.EITHER IS •a61: 9e4. PITT\(i II RHINI C(I\I AI\\tF\I'SI NII' 1)]IV I \I\Id I o,At 1 09 ' 1x)I''HIE WALL w NONF 4nH VI.VENT,VAPOR RECOVERY(VR)AND RISER FILL PIPE PIPING CONSTRUCTION VENT PRIMARY(ONIAINNICNI El I SII'H IN 4FIEC-Irl.ASS 0 III RIGID PLASTIC' W).NONE 0 os, 0fHERISj If}I 4. 4 VF NI St CONDARYCONTAINMEN I 1 fill (19 4 FIBERGLASS 0 10 RICiID PLASTIC 0 90 NONE C3 IP) l LITILRISpvlly) 4Mf 1Flll VR PRIMARY I'ONTAINMENT ❑ 1 \1191 CJ 4.FIBERGLASS 0 10 Ill PI ASTIF w).NONE 'nl OTHER ISpcal\1 IMF IFI I \'R SN ONDARY CONTAINMENT LJ 1.57111 0 4.FIBERGLASS 0 10.RIGID PLASTIC Co.NON[ El N.OTHER ISpeeifyl wh M Ih1 VENT PIPING TRANSITION SUMP T)PE L SINCLL N ALL 2.DOUBLE WALL 90.NONE ' RISI R PRIMARY CONTAINMENT' s 1 Suit U 4.F11111l LASS MU 10.RIGH)PLASOC HU 90.NONt U 99.OI'HEK0,pecify) 4" i I I RISER SECTFNDARY CONTAINMENT C1 I.STEEL 0 4IABLIl \55 0 10 RIGID PLASTIC a 91).NONE 0 99.OTHERISpecifpl IMC W.IkI FILL COMPONENTS INSTALL FD • I.SPILL FLUCKFT 3.STRIKER PLATE BOTTOM PROTECTOR N 4.CONTAINMENT SUMP 4s1+'• VII.UNDER DISPENSER CONTAINMENT(UDC) l'ONSTRII(TION TYPE. ❑ L SINGI F AAI I El -'.IX)IIRI.F W'\I I ❑ ) NO DISPFNSFRS N 90 tiONIF W'9' ('ONSTRUCTION MATERIAL ❑ I.STEEL ❑ 4.FIBER(LASS ❑ 10.RIGID PC ASIIt ❑ 99.OTHrR VIII. CORROSION PROTECTION �..� SIEFLCOMPONENI'PRO'(F('110n ❑ 3 Sa('RIFII'IAI. ANOONSI ❑ 4 IMPRFSSH)l'1'RRINI IC 6 ISOLATION IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that(his ISE system is compalihle with the hovarduus s itwonce stared and that the information provided herd6ls true,accurate. and In full cum liana,wish Ie'al ire nirrrnem APPLICANT O ILL, APPL1l A,F V%A, (pnn) 1O AI'P[K ANT TLE L David H R e Director of Real Estate Devel V PCF UST-B-1/2 Rev.(l L211007)