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"IFIED PROGRAM CONSOLIDATED FORW TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTIO1d 0^k a¢Maf 4A Y) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1 PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CON STR TtCH, I. SINGLE WALL ❑ 3. LINEDTRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFAC URER ❑ 2. DOUBLE WALL CIO. UNKNOWN ❑ 2. DOUBLE WALL ❑BB. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ 9. FRP COMPATIBLE W/UM METHANOL ❑ 1. BARE STEEL ❑ fl. FRP COMPATIBLE W/1W%METHANOL MATERMLS AND Cl 2. STAINLESSSTEEL ❑ T. GALVANIZED STEE� ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WIM CONTENTS 0. UNKNOWN ❑ 3. PLASTIC COMPATIBLE HATH CONTENTS ❑ B. FLEXIBLE(HDPE) ❑N. OTHER ❑ 4. FIBERGLASS ❑ 9. FLEXIBLE(HDPE) 1:199 OTHER ❑ 4 FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ S. STEEL WICOATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑95. UNKNOWN VN,PIPWO.LPAK OETECMN(ChabkaS iW apply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check all that epplylPRESSURIZED PIPING(Chack all that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST HATH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ q, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Chep:a9 llmt appy) ❑ 5. DAILY WSUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)'. ❑ T SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOW'. GRAVITY FLOW(Checka9 that appy).' ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ S. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(O.I GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Chacb 0 that apply): PRESSURIZED PIPING(Chock 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(c1MfA aha) ICMIX morel ❑ e. AUTO PUMP SMUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP BRUT OFF WHEN A LEAN OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONIGRAVITY SYSTEM'. SUCTIONIGRAVITY SYSTEM'. ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(CIKKI0 that apply) EMERGENCY GENERATORS ONLY(Chack 0 that apPM ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(30 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TESTI RESTRICTION ❑ 19. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 16 ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILYVISUALCHECK 1% DAILY VISUAL CHECK VN.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4 DAILY VISUAL CHECK DATEINSTALLEO ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH ALTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑ S. NONE IX OWNERIOPERATOR SIGNATURE aa19N mM ms InlameI Pmviaea herein is bw III aavlRta b Me heal M mY klpM9E9e. SIGNATURE OF OWNER/OPERATOR DATE NAME OF OWNISR/OPERATOR(pIMQ TITLE OF OWNERADPERATOR PamM Number(Far Mcal um aMy1 P«ma AppmaM(Farhat um orIA1 Mmtlt ExpkaSta Dab(Fprkxsl um Awl CUPAFORM(4/99) Forrnedy SWRCB Form B