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OPIIFIED PROGRAM CONSOLIDATED FORK TANK: TA0505870 PR #: PRO505867 FAC #: FA0007059 UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION (Check au met apply) Page 7 of9 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1. PRESSURE [12. SUCTION ❑ 3. GRAVITY 458 ❑ I. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 459 CONs,luxTWN SINGLE WALL E13. LINED TRENCH ❑99.OTHER 460 El 1. SINGLE WALL El 95. UNKNOWN 462 ,,❑1. yJ 2. DOUBLE WALL 095.UNKNOWN ❑ 2. DOUBLE WALL [199. OTHER MANUFACTURERAn $mrrk 46l MANUFACTURER 463 F11. BARE STEEL 6. FRP COMPATIBLE W 100%METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE w/ tar/.METHANOL ❑ 2. STAINLESS STEEL 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL LASTIC COMPATIBLE W/ CONTENTS [195. UNKNOWN ❑ PLASTIC COMPATIBLE W/ CONTENTS El 95. UNKNOWN I❑ . FIBERGLASS ❑ S. FLEXIBLE (HDPE) ❑ 99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE (HDPE) ❑ 99. OTHER ❑ S. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464 ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 465 VII. PIPING LEAK DETECTION (Check au that apply) (A auhnrind tome loal.getay.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Cheek all that apply): ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST ❑ 2. MONTHLY 02 GPH 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 (Check all that apply) ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM , TRIBNNIEkL PIPING ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0.1 GPH) ❑ 6. TRIENN4ll. INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW ❑ 9. BIENNIAL INTEGRITY TEST (0.1) GPH. GRAVITY FLOW (Check all that apply): ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1) GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMSAND(Chak.) ALARMS AND (Ch 4t ) F1 aa. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS E] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM pB b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION tDISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR ❑ 11, AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM ❑ 12. ANNUAL INTEGRITY 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 EMERGENCY GENERATORS ONLY (C Al mat apply) EMERGENCY GENERATORS ONLY (Cheek A]mat appy) ❑ 14. CONTINUOUS SUMP SENSOR WITH AUTO PUMP SHUT OFF • ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF e AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW ❑ ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VILL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM 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 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SUNT OFF FOR E]6. NONE DISPENSER+AUDIBLE AND VISUAL ALARMS 469 IX. OWNER/OPERATOR SIGNATURE Ica4tynce 0amfamretian Pewiddhwcin is tat an]aaw to me bat ofmyk kdge. SIGNATURE OF OWNER/OPERATOR DATE 470 NAME OF OWNER/OPERATOR (print)TITLE OF OWNER/OPERATOR 471 472 Pmrvtbhnbtr(Forloaal we only) 473 Pcmut Appt vI(Falomlm cn1y) 474 Pcmtlt&pin6m Datc(For lata) use only) 475 PT0008638 EE0000817 12/31/2003 UPCF (12/99 revised)