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BCRI-:6199 Tank UNIFIEDUNDERGROUND STORAGE TANK ORbI OPERATING PERMIT APPLICATION-TANK INFORMATION(one Tom per UST TYPE OF ACTION (Check ole item only. FnT an UST permanent closure or removal,complete only this section and Sections L 11,III,IV..and IX below) l30 ❑ I.NEW PERMIT ❑ 3.RENEWAL PERAIIT @ 5.Ct1ANOE OF INFORMATION' G.TEMPORARY UST CLOSURE 0 7.UST PERMANENT CLOSURE ON SITE 0 R.UST REMOVAL DATF I'ST PERMANENTLY CLOSED: JBoa DATE EXISTING UST DISCOVERED: J3rb L FACILITY INFORMATION FACILITY IDN(Ageim v Use Onh) 71 d5lk BUSINESS NAME(Some as FACILITY NAME or DBA-Doing Buninrss As) I Costco Gasoline(Loc. No.38) UUSINESS SI UL ADDRESS CITY Ira 1616 E.Hammer Lane Stockton IL TANK DESCRIPTION TANK ID 0 +t (� - TANK MANUFA(TL'RER ^I TANK CONFIGURATION: THiSTANK Is til C) C) I C) c�7 ❑a I-ANT NNO-ALONITANK 2 Containment Solutions ❑2.uNF IN A CO\IPAR'rM1EN'IFD UNf1'. C:r,PMle uM'n::ba fn i,.-:..pa,a_a.h-wil __._ UA"FI'UST SYSTEM INSTALLED 435 TANK C'APAC'ITY IN GALLONS4'0 NUMBI`-R OP C'OMPARTMII;N"IS IN THE UNIT- March 2004 20,000 1 111.TANK USE AND CONTENTS I AN'K LISU RI Lt MOTOR VEHICLE FIIFJ ING ❑ bMARINA FL ELIVO ❑ Ir AVIA PION FUELING ❑ 3.CHEMIICAL PRODUCT STORAGE04.HA7ARDOLISW:\STE11.,,IJ,,Uwd011105,FAIEILGFNCYGFNEM\TORFUELIFIS(bS3291,9uQ ❑ 6.OTHER GENERAL OR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER IStx<ifrl: a"IO CONTENTS PGIROLLO \1 0 I., REGULAR(.NLEAUEU ❑ to MI1/CRADIi 6NL LADLD ❑ I h.PREMIUM I.NO EAOL 13 „o ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S..PF:1"ROI.FU\I HLFMI F'UF.I. ❑ 4.01'HER PFIACA FUNI IS 'cit 1: NON-I'F.Tk01 FLIM; 7.(1SF D Off. ❑ 111,FTIIANOI 171 I I.OTHER NON-PETROLLL'\I!S scdk 1: 4,oh IV. TANK CONSTRUCTION 'IYPF.OFTANK [1 I.SING].F.\PAI.L O 2.{X)URI F.I'll I.I. ❑ 45.UNKNOWN IG PRIMARY coNrAINMIENT L,"kki l] 3,FIBERGLASS 6.1 N1'ERN AL HL A DUPR ❑ 7.STLLL 'INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Spacifyl: '1M" S11CONDARY(ON TAINMHiNT ❑ I.SI Lirl- IN 3.FIRLRGI.AS,S ❑ 6.I EXTERIOR MLMHRA\I:LINER U TJACKI ITI) 50AN0NE 5.LNKNC)W ?.{t199(THFR ISw,.i t 1IAI4AR\IS FIOTOVERFILL PRFVENTI0N FkVI\ . uy' 3.FILL TURF SHUT-OFF VALVE =31 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPINGCONSTRUC710N 0 L SINGL6W'ALLF.D -`.DOUBLE-A\NLLFD 0 99.01 HER � SYSTEM TYPE 1.PR@$SURF 1.GRAVITY 3.C'ONVENTI1N.AL.S'UCTION 4.SAFG SVCTICIN :3 CItR 5_`h3M.NtJJ J'r I'RIA/AkY("ONTAINMIFNT 1.S7i.Fi. 4.F1HFN(il:ISS • M.FI:FXIRI F 10.kIG1D I'I:\SIT(' 90.NONE ❑ 95.UNKNOWN ❑ 99.O1RLR(S •oifvl: seav SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBLRGLASS 0 II.FLEXIBLE ❑ 10.RIGID PLASTIC aMb ❑ 40.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(S wrilyl: 4M PIPIV(iTURBINE(-ONLIINMENI'SUMP TYPE I.SINGLE WALL . 2.DOUBLE WALL all NINE 1M4 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT'PRIMARY('ONI'AINMEVr 0 1.STEEL • a.FIHLRGI ASS IO RIGID PI AS II(' 'fn NONE 0 99.01HER,SInrifgl ''tivO nLl VEN'1 SLCONDAKY CON LAINMEN1 0 1.STEEL Q 4,FIHLRGL\SS ❑ 10 RIGID PLASIA ❑ 'RF NONE ❑ 49,01 HER ISrwc,l wa ,can VRPRIMAI(Y('ONTAINMIENT I.STFF1. a 4.PIf1FR6I.AS9 0 10 RIGID PI_ASTI( 9n.NONE. 0 99.OTHFR(Sp. ol ) IMG 161 1 \R SECONDARY CONTAINMENT 1.STEEL 4.FIBERC.LASS III.RIGID PLASTIC U 9D.NONE U 99.01`IIFR1SPecify) +Mt, J411.1 VENT PIPING TRANSITION SUMP TYPE n 1,SINGLE WALL EI 1.DOUBLE WALL FBI 90.NONE RISER PRIMARY CON TAINMP.NT Is I.S"I F:1d. U 4.FIHI;RfLASS U It, RIGIDPLASPIC U 9D,NONB U 99.OTHER(Specify) 4x41 44!1 RISER SECONDARY CONTAINMENT C3 I.STEEL 4.F1RERCLASS 0 IO.RIfm PLASTIC 91 9D.NONE 99.OTHER ISp,,ifyl ,blk JNki FILL C'OMIPONENTS INSTALLED 91 1.SPILL BUCKET M 3.STRIKER PLATF.:nCITTOMI PROTECTOR a 4.CONTAfNMF.NT SUMP JS1i' Vtf.UNDER DISPENSER CONTAINMENT(UDC) ('ANSI R I'C II ON I APF. IN I.SNGI EU'AII ❑ _'.DOURIT WAI I. ❑ LNOOISPFNSFRS ❑ 9I/.NONE vnv (ONSTRV( TION MATERIAL ❑ I.STEEL ❑ 4.FIBERGLASS E ID.RIGIDPLASTIC ❑ 99.OTHER ISP«irsl ae9M1"e V111. CORROSION PROTECTION U. 4.I:S S rFEI CY)\11Y1NEV(PRD'I E(-IION ❑ i.SA('NUK-I:IL ANODES/ [1J IAIPRESSEU('UNNEv'I OLAIION IX. APPLICANT SIGNATURE CEKTIFI(':YI ION: I certid that this IS'I- sten,is campalible+vlit,the hanrdous snhstance slt red and that the infnrmadon provided herein is true,accurate. and in full co 1 lianee uith Ir:al re airrolents APPLICANT NAME. p11n0 °1 APPLICANTITIT-L'IF David H Roae& Director of Real Estate Development CPC F LIST-R-112 Rrs'.(121200.7)