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r - BCF51UT99 Tank3 UNIFIED PROGRAM CONSOLIDATED FORM cam/✓) / UNDERGROUND STORAGE TANK (� OPERATING PERMIT APPLICATION -TANK INFORMATION (one Form er UST) i I r1 1 TYPE OF ACTION (Check one item only. Foran UST permanent closure or rcmoaal, complete only this section and Sections 1, ll, 111, IV, and IX below) 439 ❑ I. NEW PERMIT ❑ 3. RENEWAL PERMIT ❑• S. CIIANGE OF INFORMATION 6. TEMPORARY UST CLOSURE El 7. UST PERMANENT CLOSURE ON tiI 0 R. UST REMOVAL DATE UST PERMANENTLY CLOSFD: 4,9' I):\l1-.I-\In115O 1.5I OISC'OV ER f. D: 4366 L FACILITY INFORMATION FACILITY 1134 I:Igre13 1, Onh 1 __ I V 5 t BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) J Costco Gasoline (Loc. No. 38) 131 'SIN USS SIIEADDRESS idly lu4 1616 E. Hammer Lane Stockton IL TANK DESCRIPTION 'IA\KID" 517�T I" I%NK\I;\NI!FA('I'l'RF:R 1" I\Nk ( 1 INHIIR NITON IwS I:S\K IS 414 �a4% Q I. ANTAND-AL.ONI TANK 3 Containment Solutions ❑ 2 ONE. IN A MM PARTMF.NTFD UNIT. 1 .. nln, m. p.µo lbr eu4 amrgnnmrnl in lbunil DA I I I_'S I SYS I'FM INS "I'ALLI:D TANK CAPACITY IN GALLONS +'^ - NUMBER OF C'OMPART'MENTS IN THE UNIT Ji7 March 2004 20,000 1 Ill. TANK USE AND CONTENTS 'I AN'KI SE M IN MOT OR VEHICLE FUELING ❑ Ib MARINA FUELING ❑ Ic AVIA'r1ON FUELING 4)9 ❑ 3.CIIF.MICALPRODUCTSTORAGF. ❑ 4.IIAZARDOUS WASTE (M1Iwls Uwd Oil) ❑ 5. Fh1ERGFNC-Y GENERATOR FUF.LIHSC 4252µ151q1 ❑ 6. OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 911. OTHER IS vtf ): 414a CONTENTS PETROLEUM: ❑ 10 REGULAR UNLEADED ❑ It, MID(RO API t'. NLEADED IbPREMIUM UNLEADED 440 ❑ 3. DIESEL ❑ 5AFT FUE1 ❑ I 2%O, IATION GAS ❑ N. PE:TRO[. FUM BI.FND FUEL 1] 9. OTHER PF IItoI PCM S , E,J: i41h NON-PFTRO1 FUM 0 I. USED OII. 10. FTUANuI 11. 0171 IER NON -PETROLEUM S cuf : 449h IV. TANK CONSTRUCTION TYPF.OF TANK ❑ I. $INl1IF WALT. IB 2. DOIIB LE WALL ❑ '15.1 %KN(M N ia5 PRIMARY C'ONTAINMENI' ❑LSTEEL 3. FIBERGLASS ❑ 61N I I ION At Hl d)DI R 4M ❑ 7" STEEL + INTERNAL LINING ❑ 95. LNK\O\V\ ❑ 99. OTIIIiIt IS tify): +4+° SECONDARY GDNTAINMI':NI' ❑ L STFEI. ® 3. FIBERGLASS ❑ 6. 13 X1'I.RIOR MI kIHRA' LINT?R ❑ 7. JA(KS"FID 4+5 ❑ 90. NONE ❑ 95. UNKNOWN ❑'J9. Ol'HFR fSw,dk) 4419 OVFRFII.I. PREVENTION I. AUDIRtF & VISUAL ALARMS • '-, BALI. FLOAT ❑ 3. FILI. TURF bUU I -OFF VALVF 452 ❑ 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT! WASTE PIPING CONSTRUCTION PIPING CONSTRU'C'TION 0 I. SINGLE -WALLED IN 2 DOUBLE-H'ALLEU 0 99. OTHER 41'0 SYSTEM TYPE O 1. PRESSURE ❑ '_GRAVITY ❑ 3. CONVENTIONAL St [TION D 4. SAFE SUCTION 123 CVR t2n36Ie031 459 PRIMARY CONTAINMENT ❑ I. STEEL. Lj 4. FIBERGLASS 9 X. FLEXIBLE ❑ III. RIGID PLASTIC 41`4 ❑ 90, NONE ❑ 95. UNKNOWN ❑ 99, OTHER(S cif y): 1fr1a SECONDARY CONTAINNI I. N 1 ❑ I. STEEL ❑ 4. FIBERGLASS IN R. FLEXIBLE ❑ 10RIGIDPLASTIC +MN ❑ 90. NONE ❑ 45, UNKNOWN ❑ 99, OTHER IS r1Po1: 4M. PIPINCATTRBINE CON INvIINI NO %IP INTI ❑ I. SINGLEWALL 0 z. DOUBLE WALL 90 NONE Y 1. VENT , N'APOR RECOVERY (VR) AND RISER 1 FILL PIPE PIPING CONSTRUCTION VENT "PRIMARYCOM%1\ 11 t ❑ I N11'II • 1. HEIFRGI 4S% ❑ Io Rt61DPLASII(. 0 911. NONE ❑ 1w.(31'HER ISPs<lhl 4Ma 4Me1 VENT SACOYDARYf (1Nl A NNIIA1 ❑ I ,MEAL (] 4 I=IBI RGI ASN ❑ I0 RI(iIDPL.ASI'IC ❑ 9u NON[ ❑ ')9 OT HER ISIwrdy) Jb4f JMI VR PRIMARY CONTAINMIS I ❑ I. STFFI 17 4. FIBFRGIASS ❑ 10 RIGID PLASTIC ❑ 90. NONE El 'P). OTHER (Spnify) 4Mµ Witt VR SECONDARY CONTAINNI ISI ❑ I. STEEL ■ 4. FIBERGLASS 10. RIGID PLASTIC 90. NONE Lj 99. OTHER ISwc .fy) 4 h 4MIJ ■ VENT PIPING TRANSITION SI'Mi' I1 PL FI 1. SINGLE WALL El 2. DOUBLE WALL9D. NONE 4M' RISER PRIMARY CON 'rAINMJ\I U 1. STEEL U 4.FIHERGLASS U IO. RIGID PLASTIC 90. NONE U99. 0'1 HER (Specify) 4M) 4"11 RISER SECONDARY CONTAINMENT I. STEEL 4. FIBERGLASS ID. RIGID PLASTIC fig 90. NONE 099. OTHER(Specify) IMk 4Mkl FILL COMPONENTS INSTALLED [111 1. SPILL BUC KEE 91 3. STRIKER PLATF:BOTTOM PROTECTOR 11 4. CONTAINMENT SUMP 411'"' VIL UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION T) PF L SWOT F. w%AI 1 ❑ 2. (IOU RLF. \\ M 1. ❑ 3. NO DISPENSERS ❑ 90. NONE 4h9a ('ONSTRUCTION MATERIAL ❑ I. SUI I. ❑ 4. FIBLRGLASS IN 10. RIGID PI ASTIL' ❑ 99.OTIIER IS Ncif%l 4696, Vlll. CORROSION PROTECTION SI'EELC'OMPONENTPRUI"ECfION ❑'_ SACRIFIC'IALANODHSI ❑ 4 IMPRESSED('(' RREN 1 1] 6. ISOLATION 04N 1X. APPLICANT SIGNATURE CERTIFIEVAIION: I certify, that this UNI system is compatible with the hazardous substance slored and that the information provided herein is true, accurate, and in full coma liance wilh IvgtiLrequirrmems. APPLICANT SIGNATURE, Q` I'I APPLI('ANT NAME (pnni) APPLICA(NT TITLE. David H R ers Director of Real Estate Development UPCF UST -B - 1/2 Res. (12121117)