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UNIFIED PROGRAM CONSOLIDATED FO /nv�U� nl1 TANKS UNDERGROUND STORAGE TANKS -TANK PAGE* VI.PIPING CONSTRUCTION(Check all that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPES % 1. PRESSURE ❑ 2. SUCTION ❑ 3, GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 1 GRAVITY CONSTRUCTIO I. SINGLE WAL4 ❑ 3. LINEOTRENCH [IN. OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER X DOUBLE WAL 1 NKNOWN ❑ 2. DOUBLE WALL ❑W. OTHER MANUFACTURER Western Rberglass MANUFACTURER ❑ 1.BARE STEEL 6. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE W1 HX%.METHANOL MATERIALS AND ❑ 2, STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION ❑ 3. PLASTIC COMPATIBLE ITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE(HDPE) ❑99. OTHER PROTECTION \ ❑ 4. FIBERGLASS r . FLEXIBLE(HDPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 8. CATHODIC PROTECTION ❑ S. STEELWICOATING . 9. CATHODICPRDTECTION ❑ 5. STEELWICOATING ❑95. UNKNOWN VII.PIPING LEAK DETECTION(Check all that appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING SZSUNZED PIPING(Chacka4Nat apply): PRESSURIZED PIPING(Ched all that appy): P b.ECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDBLE AND VISUAL ALARMS I �(p�y1ARMS [32. MONTHLY 0.2 GPH TEST 21 NTHLY D 2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS(Check all Nat apply): CONVENTIONALSUCTIONSYSTEMS: ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 5. DAILY VISUAL MONITORINGOF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY TEST IDA GPH) ❑ 6. TRIENNIAL INTEGRITY TEST(0A GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELFMONITORING ❑ 7. SELFMONITORING GRAVITY FLOW: GRAVITY FLOW(Check a#Mat apply): ❑ 9. BIENNIAL IWEGRITYTEST(0.1 GPH) ❑ 8. DAILYVISUALMONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPINGSECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Che,*all that apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND Icned ane) Check one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS a. AUTO PUMP SHUT OFF WHEN RLEAKS,S STEMOCCUF DIISSCOONNECTION OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION 1 c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF X 1.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR ❑ 11, AUTOMATIC LEAK DETECTOR RESTRICTION 12. ANNUAL INTEGRITY TEST(0.1 GPH) 1112. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONIGRAVITY SYSTEM: SUCTIOWGFAVRY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Chad all that appy) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSORWITHO AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITFIOUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC LINE LEAH DETECTOR(3.0 GPH TEST) RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1, FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILYVISU&CHECK NSTALLED 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING 2001 CONTINUOUS DISPENSERPAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑ 6. NONE IX OWNER/OPERATOR SIGNATURE certify Ilial the Information prodded h true and accurate to the best of my Mwwled9& SIGNATURE OF OW NER/OPERATO DATE Oetobar 25,2067 NAME OFOWNEWOPERATOR(pr(nl) TITLE OF OWNER/OPERATOR Butch Hobson Safety and Environmental ABairs Manager Permit Number(Fic lowf Use arty) Permit ANny ed(Pb,'Iota/use Only) Permit Erpikation Date(For lawl we only) CUPAFORM(4/99) Formerly SWRCB Form 8