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AIML AUL NIFIED PROGRAM CONSOLIDATED F I UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION tuna l4nn Ivi 1151► 11111-OF ACTION (Check om hem only. For an US'l pe nlancrn closure or renl0val,complete only this section and Sections I,It,III.IV,and IX helot%► Ltt' 0 1. NL-M;t'I:R\ll'f ® 1 RENEWAL PERMIT ❑ 5.CHANGE OF INFORNIA-17ON Ej G.1 f-.MIl0RARY I1ti C CLOS(IRI: 0 7,l IS I'PI.R IANf:NT CLUS(JRE ON SITE X.UST RFMOVAl- DA 11.US'I 1'LRAIANLNILY CLOSIAX 3)(ra DATE EXISTING US-1-DISC'OVERCD: 1. FACILITY INFORMATION FACILITI'ID rr(a,r)rc t l 1c t Jolly lit NINESS NANII:(Same as FACILI I Y NA,NIL or DDA-Doing BusimeNs As) Costco Gasoline 1)I MINF.SS SITL ADI)RFSS lo' CITY lrtl IL TANK DESCRIPTION TANK ID:: 411' 1'ANK MANt 1FAC"IliRF.R 1'' TANK CONFIGURATION: nw.T.�St;Is 04 1 g Containment Solutions 911.A STAND-ALONF TANK ❑2.ONE IN A COMPARTMENTED UNIT. Car rltrc one �c fur rat awu.rnarnu m INe unn. DAA h(ISI SYSTEM INSTAL-1-41) I" LANK CAIIACITY IN GALLONS 4116 NUMBER OF COMPARTMENTS IN 111F LINA' 111' 30,000 one(1) III.TANK USE AND CONTENTS I'AtNK I1SL 13 1a MOTOR\•fill(.T.f I l'LLING ❑ Ib.MARINA WELING ❑ Ic.AVIATION 111'2/.L.M. It" ❑ .1 C'HLiMICAL PROU1'C'E SfORA(rti E34 ItAZARDC)GS\\'ASTE(dNauJnUtediAt) ❑ `•F.�IER(iEN('YCiF:NERA"lrlR l l'F.L ❑ 6 pI"UR C;E\f.RATORWEI. [30.1'NKNO\\N 13 r AYMER (S rci(%)_ t?t6 CO,'VTI.N-I S PEI'koi 1J?I ® I:t RLUVLAR 1 NI UADFD ❑ le.NIIfX;RADE UNI.F.ADED ❑ Ib.PRE\1t11NI UNLEADED 34u ❑ .1 DIESEL ❑ 5 JET FUEL ❑ 6.AVIATION GAS ❑ ;I PE IROLEVNI BLEND 111:1. ❑ 9 OTHER PETROLEUM lS cilt'1 1I"' \ON•I'F.f ICOI..I:(:NI:0 7 I'NF.D 011 ❑ Ito f:Ell AN01 I1 C1771EK\ON-1'1:fR(d.EL'\((Strcllt) u'a. IV. TANK CONSTRUCTION IYPI(OI 1'ANK ❑ 1 NINGLE WAl 1. ® ' DOUBLE WALL E395.LN-KNOWN PRIMARY CONI AINMENI ❑ L STFLI, M ? 1:11ILRGLASS ❑ 6.INTERNAL BLADDER n1 ❑ STI-11. •INTERNALLINING ❑ 95.UNKNO\\•'N ❑ 99.0'fIIER IS reit%). IIt, SI(t'O\U:\k1'Cr'i\I AfN�11'V I 1 ti fllFa. FIBERGLASS ❑ 6 EXTERIOR MEMBRANE LIKER ❑ ' lAC'KI TI_D I I° ❑ 90 NONE ❑ 95 VINKNORN ❑99.OTHER(S ufvl: O\•ILRI ILL PRI:YENT10\ M I AVDIBI-L s\7SUALALARNIS 13 , BALI Il.OAT 0 : I'ILI.TIJBE SHIT.Orl'VALVE, lo• ❑ 4 LANK NILEIS RF.QI71RENIENTs FOR EXEMPTION FROM OVERFILL PREVENTION LQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION 1'11'1X(-CON-STkt'CiION ❑1 SINGLLANALLF.D 02.DOGBLEAVALLF13 Q 99.OTHER 4.0 SYSTEM TYPE ® I PRF.SSI:kF. ❑ 2.C;k.A\'ffY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION ID CCR)]14rxo--)I Oti PRIMARY CoNTAINMEN'1 ❑ I STELt. 4 FIR ❑ S.FLERIULE 10.RIGID PLASTIC' )'d ❑ 90 NONE: ❑ 'tt L'NKNO\lN ❑ 99.07THERN5 ec1R9: 41.1. SI CONDAI(YC'ONIAINNIIN1 ❑ 1 NTFfa 0 4 FIBERGLASS ❑ 8.FLEXIBLE 0 10 RIGIDI'LASI'1(' 3631- 13 636❑ ')0 NONF ❑ 95.UNKNOWN ❑ 99.OTHLK(S)tecrfy'1: 3w; PIPING I t'RBINL CON FAIN\IENT NI.\IP'!YPE 0 t SINGLF WALL-U2.DOODLE WALL 90.NONE to4.t V1.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION \'1•.N I PRIMARY C INT AINMEN'1 L3 1 STEEL ta 4.FIBERGLASS 13 10.RIGID PLASiIC 0 90.NONE 0 99.OTHER(Specht I 4r Je M ItI \TNT SECONDARY CONIAINMF.N 1 D 1 Sl LEI. M 4 FIBEkGL.ASS 13 10.RIGID PLASTIC ❑ 90 NOtNf: 99 0111ER ISpeci(b1 4'Uf 4nli 1 \'R PRI.\IAk)'('(.)..N*lAINMENT I I,IEL'1. 4 FInfR('i1 \Nx0 It) RIGID PLASTIC ❑ 90.NONF ''r) OTHER(Sp,61%) 61e Inlcl VR SI'C'ONDARY C'(WTAIN\ILNI 1 WEFT4 FIBERGLASS 10 RIGID PLASTIC E3 90.NONE-. 99.(1'1116R Ipccifv) 4641, Il..tlr1 VLX1 PIPING I'RAKSFIION SI A116 fYP1. 1 SINWA-.\CALL. :.DOUBLE WALL 90.NONE I"Ij RISE R PRIMARY t'(IN IAINMLN'f I STFF.I. U 4 FIBERGL\SS 0 10.RIGID PLASTIC U 90.NONE 0 99.OTHLR(SptctA) t'•h u.tn RINFk SLC'ONDARY(ON'I AINMI N 11 1 -STEEL 04 FIBERGLASS 11 10.RIGID PLASTIC 90,NONE. 99 OTIIL•R(SprcDjy 1e IL IWLI 1-111 COMPONL•NTS INS'IALLED ta I SPILL BUCKET ta 3.STRIKER PLATE BOTTOM PROTECTOR 4 CONTAINMENT SL`MP 01a•, VII. UNDER DISPENSER CONTAINMENT(UDC) C'ONSTRI'CTION I YPE ❑ 1 SINGLEWALL ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ yn.NOXI: CONS 1`10 t'I ION NIA I I:RIAL ❑ 1 STfFL 50 4.FIBERGLASS ❑ 10.RIGID PLASTIC 0 99.OTHER(SN610 b+N. VIII. CORROSION PROTECTION STEEL CoMI'ONENrPRO IF.C'IION ❑ 2 SACRIFIUTALANODE(S) ❑ 4.IMPRESSEDCURRENT ❑ 6.ISOLAnON N/A 3'I� UX. APPLICANT SIGNATURE ('EWFIFICATION: I certify-that this USI'system is compatible with the hazardous substance stored and that the information provided herein is true.accurate. and In full compliance with legal requirements. APPLICANT SIONAI LIRIi t_-� �J DATE ,7rr /i 06/28/10 APPLIC'AN1 NANII.(print) 171 APPLICANT TITLE 1'= Dennis Bock Environmental Compliance Manager 14573.009.pdf L'IK'E L:51'-B-1h Ree.(12/21107)