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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION lone form 'r USTI TYPE.OF ACTION (Check ow ifein only. For an 1'ST pern)anenl cln:ure or removal.eonlplele only[his action and Seclions I.II,III,IV.and IX Ilelnu l Pb ❑ I NFIY PEHMI I ❑ I It L•NER'AI.ITRMII- ❑O 5 (1IANGFOF INFORMANO,N El G.TEMPORARY UST CLOSURE 171 7.UST PERMANENT C'LOSU'RE ON SITE 0 K UST RILMOVAt. DA MUST l'h.RMANI:NFIA'('LOSGD. 41"', D)AILFTIN I INU US I'DISCOVIF ICI"O: Il°h 1. FACILITY INFORMATION F.A('ILITY ID d Llrvn.I til.Onh 1 BUSINESS NAME(Same as FACT LI"F1'NAME of DBA-Doing Business As) + Costco Gasoline(Loc.No. 1031) BUSINLSS SI I U ADORLssrnY u 2440 Daniels Street Manteca 11.TANK DESCRIPTION LINK ID4 I': TANK MANUFAC11,10%it I:?,Kt',INInII1R>nnN. IIIKIANKIS ❑p I.A,1 Wlu-\I ON) IANK 2 Containment Solutions ❑2.oNII A(<nlrANlnn:Nu.0 nNu IlA'1"Ii US'I'SYSTEM INS FAL LISA 415 TANK C'APA('il)"IN GAIIONS +l'• NU M1SBLR OFC OMPARI'MI:NIS IN1111'.UNIT`-- +" Au us12008 30.000 1 111.TANK USE AND CONTENTS 1ANK USU [9 la NIOIOR VI:III('I F FIIFI.ISO ❑ Ill MANISA IVE1 INfi ❑ Iv AVIA[ION FIIH IMO {Ir ❑ 3.CIIF\HCAI PRODUC"r STORAtiF ❑ 4.11AEARIAl11e1VASTP.IInJuJal',.a(iIiI ❑ 5XIIIEROFNCI'6FNFRATOR FLIFL IIISt';:R+14.11 ❑ h.OTHEROENERATORFUF.L ❑ 95 UNKNOWN ❑ vv.OTBER IS uaP r. 4rx, CONTIiN18 PI:IHill FIA11 (M h, RIAHJl AI NI FAIILII Lrowc,I(:1 DF LNI I-AIllil ❑ III PRI:MI'MCNI 1»1000 I"• ❑ 3.DIFSFL ❑ 5.IFT FUEL ❑ h.AVIATION OAS ❑ R.PFl Roll F(:\f RI FNO FUf.I ❑ v,ol11FR PFTRol F(:\f (NEW,III: NON.I'F1 Rol 111kF 0 7 UNFOOII In F-nlANOI El 1l.OTIILRNON-PL1ROLf.1 M(Siv.ill: A:•h IV. TANK CONSTRUCTION 111'1:DI' IANK ❑ I.SINGIFWAII (E _'.130ti 1t'A11 45.I�VKNOWN ('HIM:\HY CON IAINNIhVI ISI F'lil. • t.FIRERtiI ASS fi.IN fPRN41 NI ROUEN JJJ ❑ 1 STEEL •ISI 1'ANAL LINMG ❑ ' HS1N KS0{l1R1N 111, S1 f1IVUAk1'tOFN 1SII• ) 1R \ VONR ❑ AKI'lIU II!@OI ASS II N.,MI 911 NONE ❑ 9i.TLV KN(111'N 9411111 FR 1.5+:n1 1 44ya Ov9;lu In I'RI'\9 N11t)N LAM/Ili1FMVIS1lA] AIAR\IS ❑ 21{All FIf1.Al L31 i FII1.1IlliFSllt)T•OrFVAIVF ❑ !.1 ASK WEIS,RE(IUIRENTENTS FOR EXEMPTION FROM OVERFILL PREVENT ION EOLIIPMEN f V. PRODUCT/WASTE PIPING CONSTRUCTION PIPINU UONSTRU('IION' 1 SIMLLFAI,' CLED 11111'-DOUBT F:VALITD 99.OTJk;R J�:• S1 STUNT TYPL ® 1.PkE5S1'Rli ❑ ±.GkA\'IT\' 1,('ON\'LNTION:\I.SV(lION ❑ l.SATLSI4'TION 'a('a tte:e;�r4 Ifr Ilk I NIA IO'CON I I N M1I F Vf 1.SIFFI • lMNFB<iI ASN % FI FXIBIF In RItrll)PIA.SI'IC Int ❑ HILMINI ❑ '1>.IINKNOW'S '2.r 9. H(SNmlil: KI; SIA UNIT:\Rl"CON LIINNIENI ❑ LSI hEL 04.1'IeCRlI1.AtiS %.FLILCIIlLL ❑ IH R1611)PL:\SU[' -0dn ❑ nu.NUNS ❑ Hi.01K1 U\'N O uv.OTI{IiR IS,:nIy 1. VIVIM; IIIRRINL CON I AINNIFN I 81 IN 11'I'F 151N�If \\.11.1. • dlkRBl FW,1Ll :RI NONF 4N: VI. VENT,VAPOR RECOVERY(VR)AND RISER If FILL PIPE PIPING CONSTRUCTION VI KI PHIMAKYCONI:MNNIENf 0 ISIFFI • I.FINFkiii N5S Ll III RI611)PI AS l IL 911,NONE vv OFIFI:R ISPVy Ibl +'�• 444.1 VI N SFI'OVU:\kl<Y)SL\INNII:NI LSI GFT. 1,FIRhHGI ASN In ItIl11P 1'I ASI II' 0 '/a NON]- '14 O111ERltipeyyl !eL {am \'R PRINIARV('IN IAINKI I N I I S1FF1 • CF141 kill ASS III kICrIDNASIR Lj 9n NOW U '19 OIIIFk I Spndyl "Ie u.ql \'R.\'@(ONUAItI'l'ON AINMI:NTLJ I.STI:rL IS 4.F1IfER111.ASS Q IR.FIRM)PLASTIC U vo.NONE 0 Sq.Cfri IER I Spc:iry l 414 "Lt VLNI PIPLN(i TR.\N51 TION AIAIP 1 YPL I.SINO J:.N':\LL • Ik)VIILF.11'ALL 90.NON!. 31 1, IOSIA PRIMARY C ON I AINNIF.NI ■ 1,SIELI U 4.1 till l(GIASS U Ill RIOID I'IASI It UH 9a.MINI U H'/.(ll'IILR ISpecily) 4141 ad f RISI:RSLC'ONIIAR\ CONTAINMENT -[L=! 11111:RGLASS El In Rtf,IDPLASII(' • 'III.NONE U v9.0'f11ER INp.eil)I Ifdk nikl I"III L'ONIPON(NTS IN TAT 1 FD • LSI'1111HA'KET • 1.STItIK'It PI.:%IFF(ITTOMPItOTPCTOR • {CONT:IINNIIfNTSIfNII' {.I„ V11.UNDER DISPENSER CONTAINMENT(UDC"') (ONSIRI14110r, IYIIk L%IN(R I•.11A1( 0 2 1)(RIM E WAl l C] 1 No O Nl'I NSI NS ❑ v1I NONF =fn: ('ONSIRITTION MAIERIAI. ❑ LSTITI" [•1 l.11IIEk(JA.%S ❑ Ill RIGID PLASTIC El 99.(11111 R,S,l,ilu In•m. \7111. CORROSION PROTECTION 511F1 ('O\IPONI'N1I'RDII.( IION 0 SACIIJI(('IAL ANODFISI El I\Il'RF,N'SFD('I'RHFVI ❑ 6ISOI AI ION •- IX. APPLICANT SIGNATURE. CER1 IFICA'I IO.Nt I certify th•((his LS'I system is compatible With the haeardous substance%lured and that the information prm idrd lierchns true.accw ale, mld in full ram I ante ainf legal i vuuircmcn )- AYPLIC'ANTg1U1A 'R-. DATE AI'PIACAN'I .�A\Il,1pmo) I'I APPI R ART TIT(II !I Davi ers Director of Real Estate Deve nt l IN"F t'S I--8- U_' Re).pzrznn7)