|
4-
<br /> Tank 4 •'..-` e 9;;:
<br /> UNIFIED PROGRAM CONSOLIDATED FORM
<br /> UNDERGROUNDSTORAGE TANK
<br /> Oeeeeeeeee
<br /> PERATING PERMIT APPLICATION-TANK INFORMATION Ione linin r GSTI
<br /> TYPE CIF A('TIO.N t('heek mm item only. Far an l'ST Ixmlunenl ciosu+v nncnxleal,emnple(a nnlF(his Seclian and Reckons 1.IL 111.R',and Li'helals 1 +'e
<br /> ❑ I NL'R'PI:lmil 1. ❑ ! IMNI'AVAL PHtMlh ❑ 5.('IIANGti OE INFORMAII(LN
<br /> G TLAIPORAR}'PST('LOSURG 7.UST PI:RMANE\T('I OSURE ON SITE K.UST RRMOVAL
<br /> DA 11'.US'I I-FRM.ANLN I"LV('LOSVD4'`°' I DA II F\IS I ING UNI DISC-OVI.RIU: lam
<br /> 1. FACILITY INFORMATION
<br /> FACILITY IDN 1.lgexl t 1 Sr Onh'i
<br /> I
<br /> BUSINLSS NAMti(Same as FA('IL1'VY NAML of L)BA-Doing Business As) r
<br /> Costco Gasoline(Loc. No. 1031)
<br /> nL!SINESS SI TE ADDRESS un ClIY uu
<br /> 2440 Daniels Street Manteca
<br /> 11.TANK DESCRIPTION
<br /> SANK IDs OT_ JANKMANUrA("1I'REIt _.�11_-�_�-----
<br /> (ANKt'nNFIliLR4IION. TRIS LINK IS
<br /> t] I,A.IT AND-\I UNI I ASS
<br /> D5a4 ^ Containment Sdutions pz,,lNt ls.A(„\u'nK1nn,N n,nut:n.
<br /> Lrpkl,oa:pee:Ln:a.l.nm
<br /> DA'I'I(VS'I SYS-I'IiM IVN'I'ALLIiD 4'1 'TANK('APAC'I'I'Y IN GALLONS NUMeI.R OF COMPARI'MIiNI'S IN THI!UNT1' - -
<br /> TBD 1,500 1
<br /> III.TANK USE AND CONTENTS
<br /> A NK URL ❑ UI MOIORV'FHI('Ik F'IiFIIN(i ❑ Ib MARINA FI H roll 1] Iv .AVIA IION Fl FLINO l9
<br /> ❑ ?.UIIF\JlVAL PRODUCT STORAOF ❑ J IIA ALRODUS%%,ASTF.rlwf4d,IN,d oilsi,
<br /> ❑ 5.FAII':IIOFN(1'CFNIiIiATOR Fl ft 11150 al:.+I Snit
<br /> ❑ 6.OTIIEROENF.RATOR FUEL ❑ 95 IINKNOWN g 99.(1111ER ISwv,l\f Fuel Addilive aw,
<br /> ('(IN"fF:N'IS YCIROI LI:M: ❑ Iv RFImll AR UVI L.ADFD ❑ Ir MR)ORAI/L I,NI FADI-U ❑ Ih YNFAIII IAI I'NI FAIIF.D uo
<br /> ❑ .1.I11ESLL ❑ 5.1FT ruFL ❑ 6.AVIATION OAN
<br /> ❑ N,P11 901 FL'\1 HI VNO F111:1 Q 4.O111FR PETROI FGM (S c. m Fuel Additive sort.
<br /> NON-1'1`71111 TAIAb0 '1 USFDOII Ia,FTIIANOI
<br /> 1L(/TIIER NON-PETROLLI"\I(S ,,dr : +Ile
<br /> IV. TANK CONSTRUCTION
<br /> 111'F.OF IANK ❑ 1.SINCIF.tVA1I U _ DO11"I I'A Al 1. ❑ 95.IIVKNl1N'K In
<br /> PRIMARY CON I AINAIF-41 o ISIELL 1198FRDI ASS R.INItRN1L"LAl1LAK 44+
<br /> ❑ 1.STEEL 'INI ERNAL LINING ❑ 95.UNRNO\1'N 94.OlIIGN IS ucip is 444,
<br /> SI(IIVDARt'('ONIAINMF.N1 ❑ I smn IN PII/1`11(:1 ASS ❑ n.1'XII.RIOK\(1 MNKAVI tINtK i IAI KI III) u:
<br /> 911 NUNF 45,IIN KN(1N'!S 44.(DIIF'R lSpwrl 441,
<br /> DY1'.KF III 1'NF VI'N(1011 LAI g11Hi F k VISI LAI AI.AKMS FI DAT1,FII 1 'I lliiP Sllll l"•UFf RVI VF 4<
<br /> El J.TANK KIEEIS REQIIIREhEms FOR EXEMPTION OVERFILL Pilm.NTION EO(UPAIENI"
<br /> V. PRODUCT/WASTE PIPING CONSTRUCTION
<br /> PI PING C'ONSTRiVI ION LSIN(iLF-R'dLI RU a �.IXR'lll E-n!MICiI W.O711FR 414,
<br /> SY'STLM f1 IT 1.PRESSURE 0 NRAVITY I] ).l'ON\'CNI I(1NAL SUCI I(1K J.SAI L SI R'TI(16 a(('R I_o+nn,L 49
<br /> PKIMAR\'CONI'AINMPN I U 1.STEFI 4 Hill NCI ASS M,FI FXIln F Ie RWID PI ASPIC m+
<br /> r-1 411.Nom ❑ 9>,UNKNON'N ❑ 99,111"1 WS •nl\'1: le,1,
<br /> ALCONDARY'UON IAINMF.NT ❑ I.S1 ELL [E 4.HER RGLA55 0 M.PLFXIDLL ❑ IO RIGID PLAST'1( I,dn
<br /> ❑ Ink NONE ❑ 45.UNKNOWN ❑ 49.OTHER 15 r,o1 I: 4,..1,
<br /> PIPINOII RRNL('Or,I AINMEN I"SLIAIP I VPI. L.SINCLL I\':\LI. • ;1111UHLt N•ALL 4(1 V(1,\I: 4144
<br /> VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION
<br /> \$NI PRIMARYCONI:\INMMFVI I,NIFLI -9 1,1`IHI:ROI.ASS U III RIGID PI AN I IC 0 91L NONE 11 (1111 11411-111 +ea.
<br /> \'I NI SECONDARY(ON IAINMl:NI 1 SILFL 94 rmml.15.ti4 .%
<br /> In K161D YLASIII' 91).NONE '1`l (11111iN Isp.•,11)i 4141
<br /> VR PRIMARY(nNt AINKiFNI I S1 FFILl 4.1 lHFK(II ASS4e411
<br /> Ll IU RIf11b PI ASI'll vn NOW 99 OfHEk(Spcatpl ods
<br /> VR SP.(ONDAR\'t'ON1"AINMLN f 141�i
<br /> L SINCI. 4. IHC IiLAN.I' o. Ili 1 STIC 911.NO 49.OT1 IER ISPsed11 4"1
<br /> VLN NrISD TRANSITION Sl!AfP T%IT 1.51y(il.li AA e 1 11 u,t1,
<br /> 1(ISI'.R I'RI\f.ARY'1nNl'AINMI'.NI LSIb.I.l a J.11"LNlitA55 III Nkill)PI..15L1n Us ne.NONI U 49.(f1'4I•.KISpe6fr) 441
<br /> RiSLRSLCONDARN CONTA-1,11i1, U 1.511(I1. LFJ 4A Ill[Rfl,AS9In RIGID PLANII9U.N41,1,
<br /> ONp
<br /> VAL
<br /> CONIPOVEN S INS :ti I FII UN I.SPIll DUl'Kiti e 3.5 v4k1
<br /> TIIIKI:N PLMhIlOTTOM PROTii(TOH ■ A.('ONTAINAIVNT SUMP 4c1„
<br /> VII.IINDFR DISPENSER CONTAINMENT(11DC)
<br /> l'ONSIRUCTIGN AT ❑ LS11161, \I A11 I3 L 1111)141 F\V'At 1. ❑ L Nll III SPL NSFRS CT nn NO10 b•'q
<br /> t'ONSTRUI'TIOR]IATP:KIA1- ❑ 1.sITI:L L] 4,1-INCNCLASS ❑ IU RIGID PLASTIC (149-Of11V.RiS <tihl 1n41•.
<br /> VIII. CORROSION PROTECTION
<br /> S I FL I w%IPONIlN I PRO I F('I ION ❑ ?.SACRIFICI:M AN(1111y51 ❑ .111IPHFSNLO('PNNL•VI ❑ Ir,INOI AI'ION +„
<br /> IX. APPLICANT SIGNATURE
<br /> CER'I1E1f'.A"I I(/A: 1 c �tij, c Chis IS'1 Salem{s eampalihle in Che haeardaus substance stared and Chat the Infarmalinn prrrvided herein is[rue,accurule,
<br /> and
<br /> InIn toll ll ro 1 dicer{xilh h"al f l� Clill'1H.
<br /> APPLICANT SIUNATURE BATE /0j,,0 ✓7 L•
<br /> ..
<br /> AI'PI.R ANI NA\IP.(pnm) 1.1 APPII('ANT TI LF •.
<br /> David H Ro ers Director o1 Real Estate DeuE v n
<br /> c'
<br /> I P('F US V-R-1,12
<br /> Hes•(12/2007)
<br />
|