BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

ti •ECE#10199 Tank3 UNIFIED PROGRAM CONSOLIDATED FORM /�� UNDERGROUNDSTORAGETANK L / 2 OPERATING PERMIT APPLICATION -TANK INFORMATION (one fo TYPE OF ACTION (Check one item only. For an UST permanent closure or removal, complete only this section and Sections I, If, III, IV, and IX below) 430 ❑ 1. NEW PERMIT ❑ 3. RENEWAL PERMIT M 5. CHANGE OF INFORMATION ❑ 6. TEMPORARY UST CLOSURE ❑ 7. UST PERMANENT CLOSURE ON SITE ❑ 8. UST REMOVAL DATE UST PERMANENTLY CLOSED: 630aI DATE EXISTING UST DISCOVERED: 4106 I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business AS) 3 Costco Gasoline (Loc. No. 38) BUSINESS SITE ADDRESS 103 CITY IN 1616 E. Hammer Lane Stockton II. TANK DESCRIPTION TANKI\aD^## �C� it I 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 01.A STAND-ALONE TANK 3 Containment Solutions ❑ 2. ONE IN A COMPARTMENTED UNIT. Com leen one pap for each cam tto tNthe unit. DATE UST SYSTEM NSTALLE 4435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 March 2004 20,000 1 III. TANK USE AND CONTENTS TANK USE la. MOTOR VEI IICLE FUELING ❑ 76. MARINA FUELING ❑ le. AVIATION FUELING 439 ❑ 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 5. EMERGENCY GENERATOR FUEL [HSC §25281.5(c)] ❑ 6. OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: ❑ ]a. REGULAR UNLEADED ❑ 1c.MIDGRADE UNLEADED 0 If PREMIUM UNLEADED 440 ❑ 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS ❑ 8. PETROLEUM BLEND FUEL ❑ 9. OTHER PETROLEUM S eci : 440. NON -PETROLEUM: [ 7. USED OIL ❑ 10. ETHANOL ❑ 11. OTHER NON -PETROLEUM (Specify): 4406 IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL : 2. DOUBLE WALL ❑ 95. UNKNOWN 443 PRIMARY CONTAINMENT ❑ I. STEEL 3. FIBERGLASS ❑ 6. INTERNAL BLADDER 444 ❑ 7. STEEL + INTERNAL LINING ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1. STEEL IN 3. FIBERGLASS ❑ 6. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED 445 ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify)-. 445. OVERFILL PREVENTION I. AUDIBLE & VISUAL ALARMS 2. BALL FLOAT ❑ 3. FILL TUBE SHUT-OFF VALVE 452. ❑ 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1. SINGLE -WALLED N 2. DOUBLE -WALLED [199. OTHER 460 SYSTEM TYPE IN 1. PRESSURE ❑ 2. GRAVITY ❑ 3. CONVENTIONAL SUCTION ❑4. SAFE SUCTION Q3 CCR §2636(.)(3)] 458 PRIMARY CONTAINMENT ❑ L STEEL ❑ 4. FIBERGLASS 8. FLEXIBLE ❑ 10. RIGID PLASTIC 464 ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS 0 8. FLEXIBLE ❑ 10. RIGID PLASTIC 4641, ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER(Spccify): 464. PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1. SINGLE WALL E 2. DOUBLE WALL ❑ 90. NONE 464d VI. VENT, VAPOR RECOVERY (VR) AND RISER / FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1. STEEL E 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 464e 464.1 VENT SECONDARY CONTAINMENT ❑ I. STEEL 0 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 46417 46411 VR PRIMARY CONTAINMENT ❑ 1. STEEL 0 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 4Mg 1 VR SECONDARY CONTAINMENT ❑ 1. STEEL N 4. FIBERGLASS ❑ 10. RIGID PLASTIC [1464 90. NONE ❑ 99. OTHER (Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE E 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 90. NONE 4641. RISER PRIMARY CONTAINMENT 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER (Specify) 464j 464'1 RISER SECONDARY CONTAINMENT ❑ 1. STEEL M 4. FIBERGLASS ❑ ]0. RIGID PLASTIC ❑ 90. NONE 99. OTHER (Specify) 464k 46,1 FILL COMPONENTS INSTALLED I. SPILL BUCKET 3. STRIKER PLATE/BOTTOM PROTECTOR 4. CONTAHJMENT SUMP 45laa-c VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE 469a CONSTRUCTION MATERIAL ❑ L STEEL ❑ 4. FIBERGLASS 0 10. RIGID PLASTIC ❑ 99. OTHER (Specify) 469b -c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODE(S) ❑ 4. IMPRESSED CURRENT 0 6. ISOLATION 448, IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this U system' c patible with the hazardous substance stored and that the information provided herein is true, accurate, and in full co ane with a e uirements. APPLICANT SIGNATURE DATE 070 November 20, 2012 APPLICANT NAME (print) 471' APPLICANT TITLE 472. Je of Gasoline V.P. UPCF UST -B -1/2 of a l I1, a Rev. (12/2007) 1�