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UNIPIED PROGRAM CON30LIDATE13 Pva>M UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANKS v a VI'.PIPING CONSTRUCTION(Check at Moo apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE I❑ 1. PRESSURE 2. SUCTION ❑ 3. GRAVITY 45a ❑ 1. PRESSURE ❑ 2. SUCTION ❑ ]. GRAVITY 459_ CONSTRUCTIOW 1' SINGLE WALL ❑ 3. UNITED TRENCH C3 N. OTHER 480 ❑ 1. SINGLE WALL C195. UNKNOWN 482 MANUFACTURER��C 2. DOUBLE WALL C195. UNKNOWN ❑ 2. DOUBLE WALL 1399. OTHER MANUFACTURER 481 MANUFACTURER 463 1.BARE STEEL 138. FRP COMPATIBLE W/100%METHANOL C31. BARE STEEL C16. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑2. STAINLESS STEEL ❑ 1. GALVANIZED STEEL ❑ 2. STAINLESS STEEL 117. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ S. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464 I ❑ S. STEEL W/COATING ❑M. UNKNOWN 465 VII.PIPING LEAK OETECTlON�(CpecV aaMaf'ippyk UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 486 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check as Mat appy): PRESSURIZED PIPING(Chad as Met apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH 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 INTEGRITY 112. MONTHLY 0.2 CPH TEST 7. ANNUAL C1 3. MONTHLY GPT TESTGRITY TEST(0.1 133.ANNUAL INTEGRITY TEST'(0.1 GPM) ❑ GPM) ❑ 4, DAILY VISUAL CHECK 2ONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check a a Mal appy): ❑ S. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING ANO PUMPING SYSTEM TEST(0.1 GPM) ❑ 8. TRIENNIAL INTEGRITY TEST(0.1 GPM) iAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING iRAVRY FLOW: GRAVITY FLOW(Chad a/that appy): S. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ a. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST IDA GPM) � SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING _ >RESSURIZED PIPING(Chad atl That appy): PRESSURIZED PIPING(Che"a9 Mat appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND ane) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AU018LE AND VISUAL ALARMS AND(Neck CONTINUOUS C1 a. a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LFJUC OCCURS 13b. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION C3b.AUTO PUMP SHUTOFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF ❑ C. NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR(].0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11. AUTOMATIC LEAK DETECTOR 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) IUCTIOWGRAVRY SYSTEM: 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS SUCTIOWGRAVI YSYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chad Y VW appy) 14. CONTINUOUS SUMP SENSOR WWM40 AUTO PIMP SHUT OFF.AUDIBLE AND EMERGENCY GENERATORS ONLY(Chad aafhat appy) VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL 3 15. AUTOWTICUNELFAKDETtCTOR(3.OGPHTESI)WM40 FLOW SMUT OFF OR ALARMS RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) 3 16. ANNUAL INTEGRITY TEST(0.1 GPM) ! i). DAILY VISUAL CHECK ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK - VIII-DISPENSER.CONTAINMENT ISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF$HEAR VALVE ❑ { DAILY VISUAL CHECK j CATEINSTALLED 488 ❑ 2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER/MONITORING ❑ ]. CONTINUOUS DISPENSER PAN SENSOR Wrnl AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ 6 NONE 469 "- .i.{IX OWNER[OPERATOR SIGNATURE - cxuy tnal bpn prniOeE n«am b uw and ameau to w Wet d my knp.le09a. iIGNATUR OF O _ER/pPERATO DATE 470 U� 13 o-rrvv LAME OF OWryEB(OPE pR u ) )I 471 I TITL OFOT W�IERRDPERA� O' 472 i 'emal Numb«(f«MKW uaa otVY1 473 I Permt Apprpvea[F«bW veeaM'1 474 I Pemat EApb10«I Date(F«kK2/uae Qn%1 475 ICF(1/99) Formerly SWRCB Form B