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LI@IFIED PROGRAM CONSOLIDATED FOR TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 2 VLPIPING.CONSTRUCTK/N.(GMaka9V .paW UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRXfTY CONSTRUCTION/ 1. SINGLE 40AFIt.. • .1:11 LINED TRENCH ❑W.OTHER ❑ 1. SINGLE WALL ❑B5. UNKNOWN MANUFACTURER ❑ 2. DOUBLEWAI;L4 , �q S5. UNKNONM • ❑ 2. DOUBLEWALL 11. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ B. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ B. FRP COMPATIBLE WI IDN,METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 1196. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE(HDPE)' . Q 9Q.OTHER ❑ 4. FIBERGLASS ❑ B. FLEXIBLE(HDPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHOG?�PROTECTION ❑ 5. STEELW/COATING ❑ 9. CATHODICPROTECTION ❑ 5. STEEL WI COATING El 95 UNKNOWN VII.PIPING LEAK DETECTION fCMck MfMfappfy) . ` UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Clack aO fMt apply): PRESSURIZED PIPING(CMM aN that apply). ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WATH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTON;AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0 2 GPH TEST ❑ 3. MONTHLY 0.2 GPT TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(CMM M flat appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(01 GPH) ❑ B. 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. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check M that ep aW: ❑ B. BIENNIAL INTEGRITY TEST(0 1 GPH) ❑ B. WILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(CMck aO fMt appy): PRESSURIZED PIPING(CMM M Oat OPPW: fO.CONTINUOUS TURBINE SUMP SENSOR NTH AUDIBLE AND VISUAL AND DMTI o a) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(rJ trona) ❑ a. AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ 5. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ 0. 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 GPH TEST)NTH FLOW SHUT OFF OR ❑ 11, AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY MST(0A GPH) ❑ 12. ANNUAL INTEGRITY TEST(01 GPH) SUCTIONIGRAVITY SYSTEM: SUCTIOWGRAVITY SYSTEM: ❑ 13.CONTINUOUS SUMP SENSOR IAUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR*AUDIBLE AND VISUAL AURMS EMERGENCY GENERATORS ONLY(CMM M fMf SPPW EMERGENCY GENERATORS ONLY(CMck M Mat appy) ❑ 14.CONTINUOUS SUMP SENSOR WITHOUTAUTO PUMP SHUT OFF-AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF-AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3-0 GPH TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK OETECTOR(3.0 GPH TEST) RESTRICTION ❑ 18,ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 18. ANNUAL INTEGRITY TEST(0 1 GPH) ❑ 17. DAILYVISUAL CHECK ❑ 17. DAILY VISUAL CHECK VOL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR♦AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCHUNER/MONITORING 03.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑e. NONE UL OWNER/OPERATOR SIGNATURE I f,Mat Oa MlMmelion PIpYMaB M.uOue afwaoDaaM M 9a mot afmY k.,almia. SIGNATURE OF OWNERIOPERATOR DATE NAME OF OVYIJERIOPEMTOR(p•Ipl TITLE OF ONMER/OPEMTOR Pa.Nu (FwkcN use ow Pound Appmaae(Fw/aPM up way) -M7 Eapkatlon Dab(Fwbctl uta oM� ..a CUPAFORM(4/99) Family SWRCB Fofm 8