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a a BCE810199 Tank2 UNIFIED PROGRAM CONSOLIDATED FORM -VAP C UNDERGROUND STORAGE TANK Q If (�L //'j OPERATING PERMIT APPLICATION - TANK INFORMATION (One to=m per USTI TYPF. OF ACTION (Check one item only. For an UST permanent closure or renwval, complete only this section and Sections I, II, III, IV. and IX below) 4'o ❑ L NEW PERMIT ❑ 3. RENEWAL PERMIT 9 5. CIIAN6E OF INFORMATION 6. TEMPORARY UST CLOSURE 0 7. UST PERMANENT CLOSURE ON SITE Ej 8. UST REMOVAL DATE ITS "r PERMANEN'T'LY CLOSED- Ji1u DAT[ FXISTIN(. I. ti t DISCOVERED: I. FAC'II-FlY INFORMATION FACILITY ID k (dgem i LCre Onh'i _ _ 7 C-' t BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) Costco Gasoline (Loc. No. 38) BUSINESS SI I I ADDRESS " city 1° 1616 E. Hammer Lane Stockton 11. TANK DESCRIPTION IA\K IU .�uq OSISL 4U TANK MANI II '\(' rl' IIH:It 411 TANK CONFIGURATION: THIS 1 nil: I> I , G1k+C1 M 1. A STAND-ALONP. TANK 2 / Containment Solutions 132.ONE IN.A COMPARTMENTED IINI'1'. DATE I'SAT SYSI"L"M INSTALLED 41 1:ANK C'APACII"Y IN GALLON> 4'6 NUMBER OP COMPARTMI:NI'S l\ n II 1 - March 2004 20,000 1 Ill. TANK USE AND CONTENTS 'TANK USE 01a M0'101tVE'HIC'LEFUFLINU ❑ Ib MARINA FI TI NG ❑ Ic AVIATION FUELING 439 0 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE. p9dmo us.,doa1 ❑ 5. EMERGENCY GENERATOR FUEL (HSC 4:52815101 0 6. OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99.OTHER IS vify): 41% CONTENTS PEI"ROLEUM, IM la. REGULAR UNLEADED ❑ Ir MIHGRADE UNLEADED ❑ Il, PREMIUM UNLEADED 449 0 3. DIESEL ❑ 5. ICT FUEL 0 6. AVIATION GAS ❑ N. PETROLEUM BLEND FUEL. ❑ 9. OTHER PETROLEUM S it ): 4an NON-I'FTR01. FUM- 0 T. USED 011 ❑ Bt. FTHANOL El 11. OTHER NON-PLTROLEL'M IS xdfv I: u9n IV. TANK CONSTRUCTION TYPF OF TANK 0 I. SINGLF WALL 2. fX1URLF W'A I.I. ❑ 95. UNKNOWN u# PRIMARY C•ONTAINMEN E ❑ 1.;'PEEL 3. FIBEROLA65 ❑ 6.INTERNAL BLADDER 444 0 1. STEEL 1 INTERNAL LINING ❑ 95. UNKNOWN 0 99. OTHER (S ifvE 444u SECONDARY CONTAINMENT ❑ I. S1'F EL ® 3. FIRFRGLASS 0 fi. I'.%l E.RIOR MFMRRANF LINER ❑ 7, JACKETED 44d ❑ 90. NONE ❑ 95. UNKNOWN 99. OTHPR fSaI' ). u5a OVERFILL PREVENTION Um 1. AUIIIBI.F R VISUAL. ALARMS O 2. BALL FLOAT 0 3, FIJI. TURF. SIIUT-OFF VALVE 45' ❑ 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT I WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION 0 1.SINGLF.-WALLED N 2. DOUBLE-W'ALLFD 0 99.071 IER 4111 SYSTEM NPL O 1, PRESSURE O 2. GRAVITY O �. ('ORVLNTIONAL SUCTION O 4. SAFE SUCTION 21 tTx #--'W4rmOH 45n PRIMARY CONTAINMENT Cl I. 5TFF1. ❑ a. FIRFRGLASS I] N. ELF.%IRI.F 0 10. KKJlD PLASTIC 4M 0 40. NONE ❑ 95. UNKNOWN 0 99.OTHHRIS cif J: 44a SECONDARY CONTAINMENT0 I. STEEL ❑ 4. FIBERGLASS O N. FLEXIBLE 0 10. RIGID PLASTIC 4W1, ❑ 'RI. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (SNi. 464. PIPINGIETRBINE CONTAINNt EN I' SUM P TYPE []I.SINGLEWALL 2. DOUBLE WALL 0911 NINE 41'!d VI. VENT, VAPOR RECOVERY (VR) AND RISER / FILL PIPE PIPING CONSTRUCTION VENT PRIMARY C•ONTAINMEN'I' L31. Sl'FEL IN 4, FIRE NGL ASS III RIGID PL AS ITC ❑ 910. NONE n 99 UI HER ISPseifyl 44a JI VEN'I'SECONDARY CONTAINMEN"I" 01 SIEE.L O4. FIBERGLASS O 10 RIGID PLASTIC ❑'NI. NONE ❑'F) 011111 R Speofy) 464f 4411 VR PRIMARY CONTAINMENT 0 I. STFFI O 4. FIRFRGLASS 0 10 RIGID PLASTIC 0 'NI. NONE ❑ 10l. OTHER (Specify) 446 4M,I VR SECONDARY CONTAINMENT 0 1. STEEL 1@ 4. FIBERGLASS Ll 10. BRAD PLASTIC M 90. NONE 0 99. OTHER ISpccify) 44h 4461 VENT PIPING TRANSITION SI'A1P 71'1'(: 11 1 9NGLE WALL 2.DO413Lf WALL • 90.NONE 44i RISER PRIMARY CONTAINMI.N I 0• I. SIFFI- 4, FIRFRGLASS In. RIIM I'I ASTIC U 90. NONE U99. OTHER (SPccifv) 4641 4W 1 RISER SECONDARY CONTAINM 1: NT D I. STEEL L1 4. FIBERGLASS In. RIGID PLASTIC [111 90. NONE 099. OTI IER (Specifv) 4644 4Wk1 FILL COMPONENTS INSTALLED • I. SPILL BC(' KI'T IN 3. STRIKER PLATF..'BOTTOM PROTF.(TOR • 4. CONTAINMENT SUMP VII. TINDER DISPENSER CONTAINMENT (UDC) C'ONSTRI'( HON TYPE I] L S1\61 I:. w At 1 0 -'. TAH; III.I. %5 m I. 0 3. NO DISPENSERS 0 'III. NONE CONSTRICTI(ISMATERIAL ❑ ESTILL 04.FIBERGL.AIS M III. RIGID PLASTIC 099.OTIIERIS if) 41'146' VII. CORROSION PROTECTION SrEEL COMPONI-NT PRUIE('I ION ❑ ]. SACRIFICIAL ANODE(S) 0 4 IMPRESSED C'URREN'T 6, ISOLATION IX. APPLICANT SIGNATURE C'F.R TIFICA'IION: I certil) tha(this CS"E system is compalihle with the hazardous substance stored and Thal the information provided herein is True, accurate, and in tall coi # lianee nigh Ie'al requirements. APPLICANT SKGNA 4m IpIint) APPLICANT T]TL David H Ra er Director of Real Estate Development mi U PCF UST -B- 112 Rcv. (12121107)