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/IFIBD PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 _ a YI, VI.PIPING CONSTRUCTION(Chock d OW apply) P"o UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1. PRESSURE 2. SUCTION E3 3. GRAVITY 450 [31. PRESSURE C] 2. SUCTION ❑ 7. GRAVITY 459 CONSTRUCTIONX I• SINGLE WALL ❑ 0. LINED TRENCH E3 m. OTHER 480 ❑ 1. SINGLE WALL ❑95. UNKNOWN 462 MANUFACTURER❑ 2 DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER 461 MANUFACTURER 467 1.BARE STEEL ❑ 0. FRP COMPATIBLE W/IW%METHANOL ❑ 1. BARE STEEL ❑ S. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2 STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION ❑ 7 PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ S. PLASTIC COMPATIBLE WITH CONTENTS ❑ S. FLEXIBLE(HOPE) ❑99. OTHER PROTECTION ❑ 4. FIBERGLASS ❑ S. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION _ ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464 ❑ 5. STEEL W/COATING ❑95. UNKNOWN 465 VII.PIPING LEAK DETECTION(UaaYaEMwrppy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 4a0 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Char,as fMf appy): PRESSURIZED PIPING(ChaptrW f t appy): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 7.0 GPH TEST WITH AUTO RUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 7.0 GP11 TEST WITH AUTO Pump SHUT OFF FOR LEAs( LEAK SYSTEM FAILURE AND SYSTEM DISCONNECTION+AUDELLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2 MONTHLY 01 GPH TEST ❑ 2 MONTHLY 02 GPM TEST ❑ S. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 7. ANNUAL INTEGRITY TEST(ILI GPH) 1f, I -` IjU1t\(\', ❑ .. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Ger,as That apply): ❑ S DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENINIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) ❑ S. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SLIFMONrTORING ❑ 7. SELF MONITORING SRAVfTY FLOW: GRAVITY FLOW(Ch.X*Y N.f appy): I 9. BIENNIAL INTEGRITY TEST(0.1 GPH) ❑ S. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING 'RESSURIZED PIPING(CINdr Y Nat appy): PRESSURIZED PIPING(Ger,ae fhaf appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(dl.& (Cher,ana) oro) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ 0. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ E. AUTO PUMP SHUT OFF FOR LEAKS SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF ❑ C. NO AUTO PUMP SHUT OFF ] 11. AUTOMATIC LINE LEAK DETECTOR(7.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11. AUTOMATIC LEAK DETECTOR ] 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) IUCTIOWGRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: ] 17. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 17. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Lack Y 0W appy) ] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND EMERGENCY GENERATORS ONLY(Gad ad that appy) VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL ] 15. AUTOMATIC LINE LEAK DETECTOR(7.0 GPH TEST)WWM40UTT FLOW SHUT OFF OR ALARMS RESTRICTION C315. AUTOMATIC LINE LEAK DETECTOR(0.0 GPH TEST) ] 16. ANNUAL INTEGRITY TEST(o.1 GPH) ❑ 10. ANNUAL INTEGRITY TEST(0.1 GPH) 17. DAILYVISUALCHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT ISPENSER CONTAINMENT ❑ 1. FLOAT MEOHAmrm THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER MONITORING ❑ S. CONTINUOUS DISPENSER PAN SENSOR�!M AUTO SHUTOFF FOR DISPENSER AUDIBLE NO VISUAL ALARMS ❑ S. NONE 4" st;.. OL OWNER)OPERATOR:SIGNATURE c," Infq llc n prwd "n Is Yue anp a 10 W.I.0.tl of my kraMedpa. SIGlU r �f�:TO DATE 470 D VAME OF OWNERIOPERATOR ) 471 T Tp OF OWN RrOPE R� " 472 T M u+ 1 i� rur� OWE - 'amM NumOar(For bW use a*) 477 I Parml Appy (F«b al tea.m7'1 474 Pamv1 EaWfa6an DM.rF«bW ua.«YYI 475 'CF(1/99) Formerty SWRCB Form B