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• 0 PICM: i (l1 94 Tank 2 UNIFIED PROGRAM CONSOLIDATED FORM�(N} UNDERGROUNDSTORAGETANK Q ff) �/ OPERATING PERMIT APPLICATION -TANK INFORMATION lone Comr per UST[ TYPE OF ACTION (Check one item only. Form UST permmnent closure or removal, complete only this sectio) and Sections 1, 11, 111, IV. and IX below) 0 I. NEW PERMIT 0 3, RENEWAL I'FRMIT @ 1, CHANGE OF INFORMATION El G. TEMPORARY UST CLOSURE 1771 7. UST PERMANENT CLOSURE ON SITE El R. UST REMOVAL DATE UST PERMANENTLY CLOSED: 430i D.ATFFXISTINGI;STDISCOVERED: Aiab 1. FACILITY INFORMATION FACILITY ID N f:lgenn' Use Onlrl 1 BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business AS) Costco Gasoline (Loc. No. 38) BUSINESS SI I L ADURLSS "" CLAY -' 1616 E. Hammer Lane Stockton 11. TANK DESCRIPTION TA\'KID;: Irf!-t 5' 4'2 'r�'li TANK MANUFA(TURFR 4'1 TANK CON FIGURATION: THIS TANK IS 9].ASTAND-ALONI'TANK 2 Containment Solutions❑ 2. ONE 1N A c'OMrARTNrpN"rED ul:rr. (.. eLla one paNe for emit ooiorvnn+rnl in lhv nnil DA [F USISl'ti l'I[NI NSI ALLIiD ')? TANK CAPACITY IN GALLON'S 4" NT'AIBIR OF COMPAR"E"MFN FS IN I HI; UNIT 1i7 March 2004 20,000 1 III. TANK USE AND CONTENTS 'TANK USE 17 Is MO I' OR VEHICLE FUELING; 0 IN MARINA FC LUNG ❑ Ir. AVIAHONFUFIINN 41° ❑ 3. CHEMICAL PRODUCT STORAGE 0 4. HAZARDOUS 1lASTF.Und'1ds Ueud oil, LJ i.FNtFRGF.NCYGFNF.I4ATORFUF.LIHSCO-'i-si5lnl ❑ (;.OTHER GENERATOR FUEL 0 93.UNKNOWN El MOTHER ISpeolfQ +am CONTENTS PL'IROLL.UM'. Q Ia. REGULAR UNLEADED 0 Ir. MIDGKADF UNLEADED 0 Ib. PREMIUM L'NLLADLII 441) 0 3. DIESEL 0 5AF.T FUEL 0 6. AVIATION GAS Cl 4. PETROLEUM IILFND FUEL 0 9. OTHER PETROLEUM IS CCIM: NON-PFTROLF.UMTO 7, USED OIL 0 IOFTIIANOL 171 II. OTI IER NON -PETROLEUM lSaccirvr 44F6 1V. TANK CONSTRUCTION TYPE OF TANK 0 I. SINGLE. WALL (M 2. DOURIT WAI.1. ❑')5. I INKNOWN IH PRIMARY CON T'AINMEN1 ❑ I. STEEL IN 1FIBEROLASS 06AN'I'ERNALBLAODLA lu ❑ 7, STEEL ' INTERNAL LINING 0 95. UNKNOWN 0 99.OTIIER (Spccij' )! 444u SECONDARY CONTAINMENT 0 I. Sl FIEL IM 1 FIBERGLASS 0 6. FXI FRIOR MEMBRANA? LINER 0 7. IACKFAN 1) W 0 90. NONE 0 95. UNKNOWN 0 99. OTHFR (S c".1": 44m OVFRFII.I. PREVENTION 0 1. AUl)BI.F. R V'I.S'UAI. AI..ARVIS � 2. BAIL FLOAT 0 3. Fll.l. TUFtF.SIIUP-01-F VAI.VF. -= 0 4. LANK MEETS REQUIREM&YTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION 0 I. SINGLE -WALLED IN 2. DOUBLE -WALLED 099, OTHER 460 3A'S I"ENI TYPE O1. PRESSURE 02. GRAFITY 01. CONVENTIONAL SUCTION 04.SAFLSII('TION[-ICCRI+n51I1+N3-'l ''?K 1, STI. 0 4, FIBFRCI ASS I7 R. FLFXIRLF 0 I0. RIGID I'I.:ASTIC 1G1 PRIMARY("ONT.AINNIENT 0 EF 0 90. NONE. 0 95. UNKNOWN 0 99.OfI4F:R(S xiF6): 4644 SECONDARY CONTAINMENT 0 1. STEEL 0 4. IIBERGL:ASS Q F. FLEXIBLE 0 10 -RIGID PLASTIC 4Hh 0 9D. NONE 0 95. UNKNOWN ❑ 99,OTNER(Sp«il}I: 464c PIPIN'GIIURBINE CONTAINMENT SUMP] YPF 01. SINGLEWALL 2DOLIBLEWALL 090. NONE 4u4d Vl. VENT, VAPOR RECOVERY (VR) AND RISER / FILL PIPE PIPING CONSTRUCTION VENT PRINIARI' CON I'AINMEN'I' 0 L 5TEEL l7 4. FIBERGLASS 0 10 RIGID PLAS IAC 0 90. NONE 0 99. 01 HI R iSpccilvl 4G4c 46Y1 VENT SECONOARY('ONI"AINMLNI' 0 I. S'IFFL IN a, FIBERGLASS 0 Ill RIGID I'LASIIC 0 Al. NONE 0 99. UIfIIHR(SpaUv) YAf 46411 VR PRIMARY ('ONTAMMENT ❑ I. STEFL M 4. FIBFRGLASS 0 0 RIGID PLASTIC 0 911, NONE 0 99, OTHER (Sp citvl 161, 1610 VR SECONDARY CONTAINMENT 1. STEEL 17 4. FIBERGLASS 0 10. RIGID PLASTIC 0 90. NONE 0 99. OTHER ISpvcify) 464h 4,41:1 VENT PIPING TRANSITION SUMPT'PE 171 I. SINGLE WALL '_. DOUBLE WALL a 90. NONE 4M1S RISER PRIMARY CON"IAINMI•N I' da LSrLEI. 0 4.FIBF.RGLAS.N' IO. RIGID PLA.S'I'IC 0 90. NOME 0 99.(ATIRR (Spevi(v) 4(41 464j1 RISER SECONDARY CONTAINMENT U I. STEEL Lj 4. FIBERGLASS D 10. RIGID PLASTIC (it 90. NONE E3 99e OTE IERISpecily) 161t 4"kl FILL COMPONENTS INSTALLED • 1.SPILL BUCKET [111 3. STRIKER PLATF.iBOTTOM PROTECTOR 1@ 4. CONLAfNMFNT SUMP 4?1+-• VEIL UNDER DISPENSER CONTAINMENT (IJDC) C'ONSTRIICTI0N TYPE da I. SINGI.F W.AI.1, 0 2. DO !RIT WALL 0 a. NO DISIT.N:iI RS 0 91). NONE 46% CONSTRUCTION MATERIAL 0 1. STEEL 0 4. FIBERGLASS ® 10.111(111) PLASTIC 0 99.OTIIER ISp,;J, l VIII. CORROSION PROTECTION STELL COMPONHNI"PRO"I'EC'I'ION ❑ 2. SAC'RIFIC'IAL ANODEIS) 04 IMPRESSEDC'URREN'1' 96, ISOLATION `- 1X. APPLICANT SIGNATURE C'ERTIFIC'ATION: 1 certiry that this CST SN:ste ill is compatible with the hazardous Substance stored and that the in rat matins provided herein is true, acem ate, mad m full rm I liana with Ir al rettuirrintnts. Slut4 e{J (,�' DA -TE hl'I'R%NT NAME tprint) 'I'I I APPL.I('YANT T1TLF "- David H Rofill Director of Heal Estate Development U'PCFUST-R- 112 Rcv. (1212007)