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Tank3 IiCii a 4:? UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(On:Lorin put UST) TYPE OF ACTION (('heck ntw item oniv. For an CST p rnwnenl closure or removal,complete rally chis section and Sections L 11,111,IV.and IX Felon) ❑ 1 NEN'1'1'ItM1I' ❑ ) RENL'.WALPITMll9 5 CHANGEOF INFORMATION El 6.TEMPORARY LIST CLOSURE D 7.UST PERM.A\A T C'LOSL'RF ON SITE D K.UST REMOVAL I)AIF.UST PII1MANI,N1'LY('I.OSF): 1's" I D.A'II•.I:XISIIN(i U1il DIS('OVI.RI-O: 1. FACILITY INFORMATION FAUILITY ID B lJgrvn I Ube Onl.w ' BUSINESS NAME(Sone as FAC'ILITN'NAML nr DBA-Duing Business As) I Costco Gasoline(Loc. No. 1031) BIISINB'Ssim ADnRLSS "" CITY 2440 Daniels Street Manteca IL TANK DESCRIPTION TANK TUX +" TANK VIANIWAC'TL'RFit 1" MASK I))SOsa'ksnnc Ilin1•\NKu II) Q I a I wo U UNI I\\I. 3 Containment Solutions ❑ , ,11",,,,Ir,R1,I, ILnIINII . DATI`.LIS]'SYSTEM INS]ALLFD RI` TANK C'APAC'I'T'Y IN GALLONS +11• NI NIIII R OF C'ONIPAR'I'MINIS IN'111V UNIT' )t' Aullust 2008 30,000 1 1 111.TANK USE AND CONTENTS 'TANK USI'. p LI MOIOK\'FHI('I,E F'IIFI INO ❑ h MARINA I L I INO 0t .AIPAI"IONFUFIINO +1, ❑ 3.CIII'MICAL PRODUCT STORAUF Q 4 HAZARDOU'S WASTE pu.ha..Il,.e OiU ❑ i.6AIFRGINCYCH KERATOR FUEL hIsc.'il+1 sWI ❑ K.OTHERCENERATORFLIEL E 45.UNKNO)sN Q 99.OTI{ER (Scall 1: Ji - CONTFNTS PLIROI HAI:: ❑ L. Rf Wil NC 1 VI I:APIO Q Ie MID(MA01 I:NI FAOFP 17 Ih,PRL'NIIOKl1'NMADI.O 1 h Q 3.UI1:si L Q 5.117 MEL Q h.AVIAT70N GAS ❑ H.M I RU(FILM Ill FNi)wri Q 9.01"IIFR PFI ROI FGAI (S au Wl: 11th NON-PF71401 T11hil 0 7 USFO Oil 0 I2 FTIIAN01 17-1 I1.OTI ILR NON-PLTROI LI'\I S wO ft : IV. TANK CONSTRUCTION '1)'PI'.OF IANK QLSINCA F.WAII IN ].DOURIf\('All ❑ 95.UNKNOWN 111 PRIMARYCON I'.AINNIFNI ❑ I SIIit-I • AFIHLK(iLASS G,INIFKNAI.HLA0DPR +++ ❑ )_Sllrl:L INTLRNALIAN(NG 095.UNKNOWN Q99 Orilrit (Sp:wi r. ITh SICUVUARYC'ONIAINKIPT-1 ❑ I SI[;I I E• 3 FIRFkGI A." Q h I XIERIOR MI KUIRANI LINIk Q 7 IA(KI.I LI) 114 ❑ 411 NUNF Ej '15 lINKN(IW'N2 BAI I 9FI4 OII{FR IS KnKI ++5' OVERfll I PRIVENI'ION 1 At IDIRI F k VISU.AI At.ARMS I'ATIN i.Fit TIMP Slllli'-Illi \'AI\'F - ❑ 4.TANK MEET S REVUIREMLNFS FOR EXEMPTION FROM OVERFILL PREVENT ION EQUIPMENT' V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING C'ONSTRUC'TION I.SINGLE-WALLED '- DOLIII E-M ALLED 0 w,OTlii!R +^" sys IT&I T1'Pli I.PRESSURE Q 2.GRAVITY ❑ 3.C-CINVENTION.ALSIVI ION ❑ d.SAIL MICTION ))unas,k,.K)I .kn PRINIAk)'IT)NI'AINKIFNI LSIRFI i FINF RGI ASS N F'1 IIXIIlIf In klf fill VI AS 1'1(' Int ❑ 911.NUN[ ❑ 95.IINKNO\\'N ❑ 99.01 Ill RIS •ulvr µ+• SL('ONDARYC'ON IAINAILNT ❑ 1.Sri EL (11) 7.FIBERGLASS Q R,FLEXIOLL ❑ In RIGIOPLASIR Inlh ❑ 911.NONE: Q 95.UNKNOWN Q 99.Onl ER INI:vh e. NI• PIPIN'U II IN LUNE('01,1AiNNIEN I-SUNII' 1)PE I SINGI F WAIL • 2.DO1161 L ih!l. 9n N(1NF. 4"+4 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VFN'I PRIMAKY CONI'AINA{LNI" 0 I.MEEL • 4.F1BFR(il A'.i D IP RI IDPIASIIC EI 911.NONE 9901'IIPR INpcal\I rr, VINI SI:CIINI)ARYCOMAINNIEN1 0 I.Si ILEI N 4.FiftWiL.ASti D II) RI(Ill)Pi ASI it 9II NOW. 99 0I1TLRISTKNily1 '^v +o w \'R PRIMARY 1'ONTAINNILNT 0 1S1rFI (M 4.FIRFRGI ASS It, RIGIDPIASII[ C1 911 NONF n4 c 111IFRISNcdyl I'•if u.t-t VR SE(ONDARY i ONTAINSir.NT I.STEEL 91 4.FTBERIiLASs El 11/ RIGID PI ASTR C1 9D,NONE C1 99.OTIIFRISpwNi +Nr JN L1 VLNT PIPING TRANSITION SUMP TYPE I.SINOLF.WALL 2.DOLIHLE WALL 0 90.NONE N•)• KISIR PRIMARY(VNI:AINMI-N 1 • I.SI ELI U 4.1 I1-11,HWAS3 MU In HIWIJ P[ASI'It U 9II,NON] Ej 99 OIIILR ISp.alyl Id) 4'411 RISER SL I'(LNDARY C'ONTAINh1ENT C3 I.STI:FI- 0 4.1 WkfiLASs 0 Iu RIGID PLASTIC 9U.NONE 0 9901'III'RlSpwif)1 I'll. InICI Fit I.t ONII'DNFNTS INS ALLEU Cill I.SPf-L RLtCKFT [it 3.STRIKI'R P1 ATF'BOTTOM PROTFC'TOR I11J d.C•ONIIUNNIIiN'r SUNII' IN+, VII,TINDER DISPENSER CONTAINMENT(UDC) C VNS1 R 1a'I ION I TPF. ❑ 1 SINGIEW'All Q• L001T RI F'A At Cl I.N(1111SI'fNSI kS F1 -111 NON[ -• l'ONSTRIWFIONMAILIUAL Q I.STLLI. OO 4.1IBIRG1ASS ❑ IU RIIALIPLASTIC 171 99.OTIILRIS,,if i +'•'•h` Vlll. CORROSION PROTECTION SIFII COVIPININI I'KOIF('IRIN ❑ SAC'KII-K IAL ANOI)FIS) ❑ -I IAII'RFS1hO(TRkENI ❑ I, ISOI AI ION - IX. APPLICANTSIGNATIIRE ( FR'1'IFIC'A'I ION: 1 ce1Ti1)that this LSI s)sfem is compaUhle xith the hniardous substance stored and that the inrmrmaltnu prm Med herein is WOO aecurule. mrd in full rum liance nUh It• n C•C nirtmsrot5. APPLICANT SIGNATURE DATE /Z1 APPLIC'ANT NAME pnnO 11 APPI.RANTT T1TLIi David H Rogers Director of Real Estate Develw..`nt L PCF US1-11- P2 Rc).(I V1111117)