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MAY-20-2005 11 :33 AM RAH EHVIROHMEHTAL INC 916 652 8955=PIPING .. P. 044 .... OSUNIFIED PROGRAM CONSOLIDATED FORUNDERGROUND STORAGE TANKS - TAVL PIPING CONSTRUCTION(Ch-e m am apply) SYSTEM TYPE ❑1.PRESSURE ❑2.SUCI'LON ❑3.GRAVrtY 456 ❑1.PAISSURE [12. SUCTION ❑3.GRAVITY 459 CONSTRUCTION ❑1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 460 ❑1.SINGLE WALL E3 95.UNKNOWN 463 ht ANiPACTUREA O 2.DOUBLE WALL 95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461 MANUFACTURER_ �] 1.BARE STEEL ❑6.PRP COMPATIBLE w/100% MBITiAN01. 1.BARE STEEL _ ❑6.PRP COMPATIBLE W/t00%h�IAANOL (]2.STAINLESS STEEL Cl 7.GALVANIZED STEEL I ❑Un>�w'n ❑2. STAINLESS STEEL ❑7.aALvANIZBD STEEL (]3.PLASTIC COMPATIBLE W/CONTENTS 1]99. Othm ❑3. PLASTIC COMPATIBLE W/CONTENTS o S.9MML13(HDPE) ❑99. OTHER o 4.FIBERGLASS ❑e.FLE)aaLE(HDPE) ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION 5.STEEL W/COATING ❑9.CATHODIC PROTECTION 464 17 5. STEEL W/COATING ❑95.UNKNOWN d65 .PIP GL9MC DETECTION(Cheek a0 tlM apply)(Atm a bind m roe bmlSRencF.) RO SINGLE WALL PIPING 466 SINGLE WALL PIPING 07 PRESSURIZED PIPING(Cheri W mawPlft PRESSURIZED PIPING(Chink W t appy): 1.ELECTRONIC LME LEAK DETECTOR 3.0 OPH TEST WITH AUTO PUMP SHUT ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST WITH AUTO PUMP EM OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DNEONNECIION+ ASHOT OFF FOR LEAK,SYST UDIBLE AND VISUAL A[ARMS.AILtfA$AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS ❑2.MONTHLY 0.2 OPH TEST ❑2. MONTHLY 0.2 OPH TEST Q 3,ANNUAL IN WRTrY TEST(O.IGPH) ❑3.ANNUAL INTEGRITY TEST(OAGPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCI'fON SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Cbeat W mat VpIY) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPh) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPINO): ❑6. TRIENNIAL INTEGRITY TESL(0.1 GPIs) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PDING) GRAVITY FLOW Cl 7. MFMONITORING (]9.BIENNIAL INTBGRrrY TEST(0.1 GPM GRAVITY FLOW(Chmt all m VPIO [39, DAILY VISUALMONrTORING (]9. BIENNIAL DREORITY TEST(0.1 GPM SECONDARD.Y CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Owk ill inn R*N PRESSURIZED P71NO(Leaek m ma app1Y): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(a ane) ALARMS AND(Ch ar) (]a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑4 AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM [3 b AUTO PUMP SHUT DISCONNECTION OFF FOR LEAKS SYSTEM FAILURE AND SYSTEM DISCONNECTION [3a. NO AUTO PUMP SHUT OFF Qe NO AUTO PUMP SHUT OFF ❑11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TSM WITH FLOW SHUT [3 11, AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION C]12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRrrY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS WARRGENCY GENERATORS ONLY(Chat all thm.WY) EMERGENCY GE 9BRATORS ONLY(Chae3t all Mat iWPIY) ❑14. 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 17 15. AUTOMATIC LME LEAK DETECTOR(3.0 GPM TEST)W17]TOUT FLOW 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION 16.ANNUAL INTEGRITY TEST(0.1 GPM ❑16.ANNUAL INTEGRITY TEST(0.1 GPM ❑IT DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VIII.DISPENSER CONTAROaNT DISPENSER CONTAINMENT ❑I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE MSTAI l En 4a ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING [13,CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 13 6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS LC.OWNER/OPERATOR SIGNATURE t cenry Au the ill(ptrnatim Aesain u nue avd e ro tM h 9FmY km 1 9-. SI OPERATOR DA C /I; h� R 0034 4 N F PRATOR(pn T O i r�O� T R AMj�Y' _ �"". OWn2Y ?rn t Numb (Fu wd usa oat 413 Pa t A;; (Far ura oalY) Pmnihtxpireean Daoc(Far Iml oNY 475 UPCF(1/99 revised) 175 Formerly SVrRCB Form B