BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

F-1 A 'A I'.lA ii 13flll UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERNIIT APPLICATION - TANK INFORVIA ' nc C I USTI TYPE OF ACTION (Check one item only. For ❑ST pco" Int closure nr renmval, complete only this section and Sect [+.,' I, 11, Vy�and below) mm"Imm+)° j . ❑ L NEW PERKIIT ❑ 3. RENETAL PERMIT I] 1. CIIAN0 (�I AT10N 6. TEMPORARY LIST CLOSURE T UST PERMANENT C'LOSCRE ON SITE R. UST REM DATE UST PERMANENTLY CLOSED: 'I'+" D:1'rfl f_XISTINC,LIST DISC'OV'FRr D- 'I'rh 1. FACILITY INFORMATION FACILITY ID N fagenrw Use 0n1i t BUSINESS NAME (Salic as FACILITY NAME or DBA -Doing Business As) + Costco Gasoline (Loc. No. 38) BUSINESSSTLEADDRESSp MY a 1616 E. Hammer Lane Stockton If. TANK DESCRIPTION 'TANK IDX 1i TANK \T;\NUFACTLIIF.R L'I IANKCONFIGURATION: THIS'rANKIS HI 3 Containment Solutions ❑� 1. A STAND-ALONF TANK ❑_ ONF IN A CO\IPARTMEN IED UN'I"I t 1, i, In. vie rnpa Lv m i,onlyonnlanl in the nail. DATE UST SYS 'I"lih1 INS'T'ALLI; D A%` TANK C'APACIT'Y IN GALLONS 1", NLINi BI-.ROPCOKIPARI',MUNI-SINTHLUNI'I'------- -- --pMarch 2004 20,000 1 111. TANK USE AND CONTENTS TANK USL ❑a 61 NJ() I OR VEHICLE FUELING ❑ Ill . MARINAFRLING❑ Ic. AVIA '1'ION FULLING Ale ❑ 3.CIIF\IIC-ALPRODUCr STORAGF, ❑ 4.IIAZARDOUSW'ASTEUndvdc U,ed Oill ❑ 5. EMERGENCY GENERATOR FUEL 114SC a?re I!lU1 ❑ 6.OTHERGENERATOR FUEL O 95UNKNOWN❑ 99. OTHER (Specw): uv, CONTENTS PET"ROLLUNI; ❑ la REGULAR 1, NLLAUED ❑ Ic. NHDCd(ADE I,: NI -LADLE) IN Ib. PREMIUM UNLEADED 4I1, ❑ 3. DIESEL ❑ 5.IETFLTL ❑ 6. AVIATION GAS ❑ X. PETROLEUM BLEND FUFL ❑ 9. 01 HER PE 11101 FLAT (S v6AIT VW, NON-PF..TRQI.FUM: ❑ T. USED OIT. LJ 14 PTIIAN(TI. I (.OTHER NDN-PETROLEC\f 1N xcif": ueh IV. TANK CONSTRUCTION TYPE OF TANK ❑ I. SINGLE WALT. I] =. DOIIAI F.\7111A. ❑ 95. 1INKNOWN IU PHIMARYC'ONIAINIslin ❑ I.S'IEEL Q 3. PIRERGLASS ❑ 6. IN'FLRNALBLILIDER 111 ❑ T. STEEL I INTERNAL LINING ❑ 95. UNKNOWN ❑ 99.OTIILR (SPccify): 444e SFCONDARY CONTAINMENT ❑ I. STEEI. Q 3. F1131'RGLASS ❑ 6. HXTI'.RI01( VIIf NIARANI; I.INER ❑ T IACKI'TGD 113 ❑ 9d. NONE ❑ 9i, UNKNOWN ❑ )9. OTHER (5 tiaPol; 415n OVERFILL PREVENTION O 1, AUOIHI F. & VISUAI. ALAR\IS I] 2. HALL FLOAT ❑ 3. FII.(. TURP SHUT-OFF VALVE -. ❑ 4. TANK MEETS REQL11RESIENTS FOR EXEMPTION FRONT OVERFILL PREVENT -ION EQUIPMENT V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING COS3TRCCTION L SINGLE -WALLED • L DOUIILE-WALLFD 099.0111ER leu SysrENl 11PE 1.PRESSURE ❑ 2.GRA'IT" 113,CONVEN'r10N.AL.S'UCIION 04.5AFESt1CT10NISCt'ael6k^:'✓3'I Ss I,RIMAR) ('QNrAINNTNT ❑ 1. STEFI. i PI III( ASS ❑a M, FL FXIIII. F. ❑ 10. RIGID PLASTIC Int ❑ 90, NONE ❑ 95.UNKNO\VN ❑ 92111 HI:RISu61VC aNa SECONDARY C'ONLVNMENT ❑ 1. STEEL ❑ 4. I'IBGRGI.A. Q , FL Ii XI ALG ❑ 10. RIGID PLASTIC 464b 90. NONE ❑ 9i. UNKNOWN ❑ 99.OTHER(SP,lt`,1: 4n, PH'IN('FL'RBINE('UNIAINKIENI SUNIP Mill, ❑ I. SINGLE WALL 0 2.DUUBLE41'ALL ❑ 90 NONE 114E VI. VENT, VAPOR RECOVERY (VR) AND RISER/ FILL PIPE PIPING CONSTRUCTION VENT' PRIV.ARY CONTAINNIM El1. STEEL• yFINhRULASS 10 KIGID PLAS IIC ❑ 9n. NCNF ❑ VV,(1fHLRISPvoJ.%j 464, 1Wd VLN'I SI ('O,NOAKYCONI'AINNIBNI❑ I. SI EFL (9 i. 1'IHERGLASS ❑ It IIIGID PUTS NC ❑'n) -NONE ❑ 99. 0IHER,Spccil4) YAF 46411 VR PKINIVO t'(INTAINNIFNT ❑ 1, SIFFI. • 4. FIBFR(IIANS ❑ In RIGID PI ASTIC 0'111, NONE ❑ 99.0"FHF.RISpe:1fy1 AWS. 1610 VR SELr I)ARYCONTAINKIENT C1 I. STEEL IN 4. rIBER61ASS 0 10. RHAD PLASTIC 0 911. NONE D 99.OTIIERISp,ilyi 11th V[NT I'IPIM; I2INSITION SUMP TYPE 1. SINGLE WALL 2. I>nUULB WALL [jI 0. NONE Ana, IUSIfK PRIMARY CONI'AI.NNIENr JRN 1. SIERT. U 4. 19131.101LASS ❑ IO. RIGI1) PLASTIC ❑ 9f1. NONE ❑ 49. CII'HhR ISpe<ilyi 4611 4(411 RISER SECONDARY COST n INNIENT I. STEEL 04. PIAERGLASS 10. RIGID PLASTIC a 9n.NONE 0 99.OTIIER(Speci1`y) 1611 11111 TILL COMPONENTS INSTALLED • L SPILL BUCKET • 3. NTIIIKEIt l'LATF'BOTTONI PROTEc root 91 :,CONT:\INKIEV-T SUA1P 41"e VII. UNDER DISPENSER CONTAINMENT (UDC) ('ONSTRIA110N 11 Pr, ❑R 1. SINCI F, WALT. El 2. DOUBLE W'AI.L ❑ 3. NO DIM.FNSFRS ❑ NC NONE CONSTRUCTION MATERIAL ❑ I. STEEL ❑ 4. FIBCR \1S 9 IO.RRIMPLASTIC ❑ 99.OTIILRiSp,6Fi VIII. CORROSION PROTECTION SEELLCOMPO,NTNI PROILC110% ❑ 2. SACRIFICL\LANUDL(s) ❑ 1 INmRESSEDCUItRLNF O n.ISOLAIION IX. APPLICANT SIGNATURE C F. IT PI FI CATION: I c(rtTI'V Thal (his CST system is coulpalibIt vv it ll the hazardous substance stored and (hal the Information provided herein is True, accm ale, and in full coo Hiatlee Wilh lea t• nirnmlcnls. APP( (CANT RI["NATIfRF (\ Vooe J/ :;11 APPLICANT NAME 411mr) °I APPLICANT TITLE "- David H Rers Director of Real Estate Development U PCF LEST -11- 1.12 RCA. (1212817)