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,IED PROGRAM CONSOLIDATED FO r TANKSDZ UNDERGROUND STORAGE TANKS - TANK PAGE 1 I (Two pages per tank) TYPE OF ACTIONPage_5_of 6 ® 1.NEW PERMIT ❑ 4.AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION ` (Check one item only) ❑ 3.RENEWAL PERMIT ❑ 6.TEMPORARY TANK GLGSDRE 470. ❑ 7.PERMANENTLY CLOSED ON SITE O (Specify reason) (Specify recon) BUSQVE$$NAME(Sanv:u FACILITY NAME or DBA- g ❑ B.TANK REMOVED Win Iinsi As) 3. FACILITY ID: COSTCO GASOLING LOC. NO 38 A �TQ 1 LOCATION WITHIN SITE(opurmao 431. I.TANK DESCRIPTION T��Agq�(N�7 (A scaled plot plan with the location of the UST system including buildin s and landmarks shall be submitted to the local agency.) K ID 71 432. TANK MANUFACTURER 471. T�DeS SlosD COMPARTMENTALIZEDTANK El Yes No 434. CONTAINMENTSOLUTIONS If"YesTcomplete one page for eachcompanmenr. DATE INSTALLED 435. TANK CAPACITY W GALLONS 436. (YEAR/MO) NUMBER OF COMPARTMENTS 10/02(estimated) 20,000 437. ADDITIONAL DESCRIPTION(For local nae only) 1 438. II.TANK CONTENTS TANK USE a39. PETROLEUM TYPE ® 1. MOTOR VEHICLE FUEL ®Ia. REGULAR UNLEADED 440. (Ifchecked,complete Petroleum Type) ❑2. LEADED ❑5. JET FUEL ❑Ib. PREMIUM UNLEADED ❑3, DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑ IC. MIDGRADE UNLEADED ❑4. GASOHOL ❑ 3. CHEMICAL PRODUCT 1199.OTHER: COMMON NAME (from Hazardous Maleriak il)o87 OCTANE Invemory page) 411' CA$#(from Hazardous Materials lnvamcq page)❑ HAZARDOUS uS WASTE 44:' Oecwaleea used 1U 8006-61-9 ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE on TANK ❑ L SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR (Check one item only) ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM a43. MEMBRANE LINER ❑95. UNKNOWN TANK MATERIAL-prinury ®2' DOUBLE WALL ❑4. SINGLE WALL IN A VAULT ❑99, OTHER taNr ❑ 1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE (Checkore item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERCLASS ❑95 UNKNOWN 444' ❑8. FRP COMPATIBLE ❑99.OTHER: TANK MATERIAL-seconds tank REINFORCED PLASTIC(FRP) W/100%METHANOL rY ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑8. FRP COMPDBLE W/100%METHANOL (Check one item only) ❑2. STAINLESS STEEL [195.UNKNOWN a5. ❑4. STEEL CLAD W/FIBERGLASS ❑9. FRP NONCORRODABLE JACKET 1199.OTHER REINFORCED PLASTIC(FRP) ❑!0. COATED STEEL TANK INTERIOR LINING ❑5. CONCRETE ❑1.RUBBER LINED ❑3.EFOXY LINING ❑5.GLASS LW WG ❑95.UNKNOWN OR COATING El2.ALKYD LINING ❑4.PHENOLIC LINING ®6.UNLINED 446 DATE INSTALLED 4a]. (Check one item onl ) ❑99.OTHER OTHER CORROSION ❑I.MANUFACTURED CATHODIC ®3.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN a48. DATE INSTALLED 449. PROTECTION PROTECTION (If A licable) ❑2.SACRIFICIAL ANODE ❑4.BdPRFSSED CURRENT 1199.OTHER SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ®1,SPILL CONTAINMENT ®1 ALARM ®2.DROP TUBE ®2.BALL FLOAT_ El 3.FILL TUBE SHUT OFF VALVE ®3.STRIKER PLATE ❑4.EXEMPT _ IV.TANK LEAK DETECTION (A IF SINGLE Wdescri lion of the monitorin ---in shall be submitted to the local agent .) ALL TANK (Check all that apply) 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. ❑1. VISUAL(EXPOSED PORTION ONLY) (Check one item only) ❑S.MANUAL TANK GAUGING(MTG) ❑ 1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE ®2.CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SER)+BIENNIAL TANK TESTING 1199.OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE INPLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? 457. gallons ❑Yes ❑ No UPCF hwfwrc-b(t/99)-1/4 hftp9/www.unido org Rev.02!16/00