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�9rdFIED PROGRAM CONSOLIDATED FOL.44 <br /> TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Check all mat applyTwo,4 of e <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE ®1.PRESSURE D 2.SUCTION [13.GRAVITY 458 ❑ 1.PRESSURE D 2. SUCTION D 3.GRAVITY 459 <br /> CONSTRUCTION ®1.SINGLE WALL ®3.LINED TRENCH D 99.OTHER 460 ❑1.SINGLE WALL D 95.UNKNOWN 462 <br /> MANUFACTURER D 2.DOUBLE WALL D 95.UNKNOWN D 2.DOUBLE WALL D 99.OTHER <br /> MANUFACTURER AO Smith 461 MANUFACTURER_ 463 <br /> D 1.BARE STEEL D 6.FRP COMPATIBLE W/100% METHANOL D 1.BARE STEEL D 6.FEE COMPATIBLE Wilma,METRANOL <br /> D 2.STAINLESS STEEL D 7.GALVANIZED STEEL D Unknown D 2. STAINLESS STEEL D 7.GALVANIZED STEEL <br /> D 3.PLASTIC COMPATIBLE W/CONTENTS D 99. Other D 3. PLASTIC COMPATIBLE W/CONTENTS D 8.FLEXIBLE(HDPE) D 99. OTHER <br /> ®4.FIBERGLASS D 8.FLEXIBLE(HDPE) D 4. FIBERGLASS D 9.CATHODIC PROTECTION <br /> D 5.STEEL W/COATING ®9.CATHODIC PROTECTION 464 D 5. STEEL W/COATING D 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECCION(Checkalhlat apply)(A cription orthe rnaarkoring proqpann shall be sabroinedto the local <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> ®1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNF,CTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> ®2.MONTHLY 0.2 GPH TEST D 2. MONTHLY 0.2 GPH TEST <br /> ®3.ANNUAL INTEGRITY TEST(O.IGPH) D 3.ANNUAL INTEGRITY TEST(O.IGPH) <br /> [34. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> D 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING D S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUND PIPING): D 6. TRIENNIAL INTEGRITY TEST III GPH) <br /> [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 2 7. SELF MONITORING <br /> D 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): <br /> D 8. DAILY VISUAL MONITORING <br /> D 9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Cheek all thea apply): PRESSURIZED PIPING(Cheek all flat apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR W AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check ) ALARMS AND(Check one) <br /> ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUP"SHUT OFF WHEN A LEAK OCCURS <br /> ❑b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> On. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> D 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT D 11 AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> D 12. ANNUAL INTEGRITY TEST(0.1 GPH) D 12. ANNUAL INTEGRITY TEST(0.1 GPM <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> D 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS D 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Chock all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> D I5. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW <br /> SHUT OFF OR RESTRICTION D 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> D 16.ANNUAL INTEGRITY TEST(0.1 GPH) [116.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> D 17. DAILY VISUAL CHECK D 17. DAILY VISUAL CHECK <br /> VID.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT D 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 [12.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ®5.TRENCH LINER/MONITORING <br /> D 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6.NONE 469 <br /> IX.OWNER/OPERATOR SIGNATURE <br /> I wniry dw the Nfommlon vidcd u accurate ro the best error,krwaleep. <br /> SIGNATURE OF O DATE 470 <br /> QX LrE4U 1 10/29/02 <br /> NAME OF O 'nt) TITLE OF OWNER/OPERATOR 472 <br /> Chevron Products Co an /D.R.LERI Retail ESH Specialist <br /> Permit Number(For local use only) 473 Permit Approved(For local we only) Permit Eapintion Date(For local we only) 475 <br /> UPCF(1/99 revised) 176 `e Formerly SWRCB Form B <br />