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D PROGRAM CONSOLIDATED FO 3 3 b � TANK UNDERGROUND STORAGE TANKS- TANK PAGE 2 b� VL PIPING CONSTRUCTION cnakaEdun Palle z of a UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE ❑2.SUCTION ❑3.GRAYTIY 458 ❑1.PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 CONSTRUCTION ®1.SINGLE WALL ®3.LO]ID TRENCH ❑99.OTHER 450 ❑L SINGLE WALL ❑95.UNKNOWN 462 MANUFACTURER ❑2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER AO Smith 46I MANUFACTURER_ 463 ❑L BARE STEEL, ❑6.FRP COMPATIBLE W/IO; METHANOL ❑L BARE STEEL ❑6.FRP COMPATIBLE W1100%METHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑Unknown ❑2, STAINLESS STEEL ❑7.GALVANIZED STEEL Cl 3.PLASTIC COMPATIBLE W/CONTENTS ❑99. Other ❑3. PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPE) ❑99. OTHER N 4.FIBERGLASS ❑8.FLEXIBLE(HDPE) ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING ®9.CATHODIC PROTECTION 464 ❑S. STEEL W/COATING ❑95.UNKNOWN 465 "T PIPING LEAK DETECTION Cherka (A of the maAomg proparn a l be submitted"local UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Checkell a appy} PRESSURIZED PIPING(Ch all thatapply): ®1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ®2.MONTHLY 0.2 GPHTEST ❑2. MONTHLY 0.2 GPHTEST ®3.ANNUAL INTEGRITY TEST a iGPM ❑3.ANNUAL INTEGRITY TEST(0.IGPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all thm apply) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPM ❑5. DAILY VISUAL MONrTORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUND PIPING): [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW [3 7. SELF MONITORING ❑9.BIENNIAL INTEGRITY TEST(o.I GPM GRAVITY FLOW(Check all that apply). ❑8. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPM SECONDARILY CONTAINED PIPING SECONDARELY CONTAINED PIPING PRESSUR12ED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Chink one) ALARMS AND(Check one) ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTOPUMP SHUT OFF WHEN A LEAK OCCURS Ob. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM [I b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION C]c. NO AUTO PUMP SHUT OFF []c NO AUTO PUMP SHUT OFF 0I L AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION 11. AUTOMATIC LEAK DETECTOR [112. ANNUAL INTEGRITY TEST(0.1 GPM [112. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS [113, CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all tlatt amply) EMERGENCY GENERATORS ONLY(Check all that appy) [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WTITTOUI'FLOW SHUT OFF OR RESTRICTION I5. AUTOMATIC LINE LEAKI)EI'ECfO1C(3.0 GPH TEST) [116.ANNUAL INTEGRITY TEST(0.1 GPM [116.ANNUAL INTEGRITY TEST(0.1 GPM [117. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VDI.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK DATE INSTALLED 468 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ®5.TRENCH LINER/MONITORING 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6.NONE 469 IX,OWNERIOPERATOR SIGNATURE I comfy Nat the mfbm upmvided haem®true and amumte m the beat nfmy bawledee. S TUBE OF QWNEWOPERATOR DATE 470 /fm Diane Leri 12/23/02 NAME OF WNE OPERATOR(pnm) All TITLE OF OWNER/OPERATOR 472 Chevron Products Company 1411. (� Retail ESH Specialist Pemdt Namber(I.kcal Dae ony) 473 Peemn AppmvM(For local uae Doty) PamhE pvmion Oete(For tical use ony) 475