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v <br />UNIFIED PROGRAM (UP) FORM 131b7 <br />UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br />VI. PIPING CONSTRUCTION (Check all that apply) Page Of <br />UNDERGROUND PIPING <br />ABOVEGROUND PIPING <br />SYSTEM TYPE ® 1. PRESSURE D 2. SUCTION 03. GRAVITY 458 <br />D 1. PRESSURE D 2. SUCTION D 3. GRAVITY 459 <br />CONSTRUCTION D 1. SINGLE WALL D 3. LINED TRENCH D99. OTHER 460 <br />D 1. SINGLE WALL D 95. UNKNOWN 462 <br />MANUFACTURER ® 2. DOUBLE WALL [195. UNKNOWN <br />[12. DOUBLE WALL D 99. OTHER <br />MANUFACTURER ENVIRON 461 <br />MANUFACTURER 463 <br />MATERIALS AND 1 BARE STEEL ❑ 8. FRP COMPATIBLE w/100% <br />CORROSION METHANOL <br />Ell. BARE STEEL ❑ 6. FRP COMPATIBLE W1100% METHANOL <br />PROTECTION <br />❑ 95. UNKNOWN D 2, STAINLESS STEEL D 7. GALVANIZED STEEL <br />02. STAINLESS STEEL D 7. GALVANIZED STEEL <br />D 3. PLASTIC COMPATIBLE W/ CONTENTS ® 8. FLEXIBLE (HDPE) <br />D3. PLASTIC COMPATIBLE <br />g FLEXIBLE (HDPE) (] 95. UNKNOWN <br />W/CONTENTS <br />D 4. FIBERGLASS D 9. CATHODIC PROTECTION <br />D 4. FIBERGLASS D 9. CATHODIC PROTECTION <br />D 5. STEEL W/COATING D 99. OTHER 464 <br />1 D 5. STEEL W/COATING D 99. OTHER 465 <br />VII. PIPING LEAK DETECTION (Check all Mat apply) A Omcription of the monitoring prorem shall be submitted to the local agency.) <br />UNDERGROUND PIPING <br />ABOVEGROUND PIPING <br />SINGLE WALL PIPING 466 <br />SINGLE WALL PIPING 467 <br />PRESSURIZED PIPING (Check all that apply): <br />PRESSURIZED PIPING (Check all that apply): <br />D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br />D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br />SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM <br />SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM <br />DISCONNECTION + AUDIBLE AND VISUAL ALARMS. <br />DISCONNECTION + AUDIBLE AND VISUAL ALARMS. <br />D 2. MONTHLY 0.2 GPH TEST <br />[12. MONTHLY 0.2 GPH TEST <br />D 3. ANNUAL INTEGRITY TEST (0.1 GPH) <br />D 3. ANNUAL INTEGRITY TEST (0.1 GPH) D 4. DAILY VISUAL CHECK <br />CONVENTIONAL SUCTION SYSTEMS (Check all that apply) <br />CONVENTIONAL SUCTION SYSTEMS (Check all that apply) <br />D 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING <br />INTEGRITY TEST (0.1 GPH) <br />D 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br />D 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) <br />SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): <br />SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): <br />D 7. SELF MONITORING <br />D 7. SELF MONITORING <br />GRAVITY FLOW <br />GRAVITY FLOW (Check all that apply): <br />D 9. BIENNIAL INTEGRITY TEST (0.1 GPH) <br />08. DAILY VISUAL MONITORING 09. BIENNIAL INTEGRITY TEST (0.1 GPH) <br />SECONDARILY CONTAINED PIPING <br />SECONDARILY CONTAINED PIPING <br />PRESSURIZED PIPING (Check all that apply): <br />PRESSURIZED PIPING (Check all that apply): <br />10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br />10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br />ALARMS AND (Check one) <br />ALARMS AND (Check one) <br />D a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />D a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND <br />D to AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM <br />SYSTEM DISCONNECTION <br />DISCONNECTION <br />Dc. NO AUTO PUMP SHUT OFF <br />Oc NO AUTO PUMP SHUT OFF <br />V 11. AUTOMATIC LEAK DETECTOR (3.0 GPH TEST) W ITHFLOW SHUT OFF <br />D 11. AUTOMATIC LEAK DETECTOR <br />D 12. ANNUAL INTEGRITY TEST (0.1 GPH) <br />D 12. ANNUAL INTEGRITY TEST (0.1 GPH) <br />SUCTION/GRAVITY SYSTEM <br />SUCTION/GRAVITY SYSTEM <br />D 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS <br />1-113. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS <br />EMERGENCY GENERATORS ONLY (Check all that apply) <br />EMERGENCY GENERATORS ONLY (Check all that apply) <br />D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br />D 14. CONTINUOUS SUMP SENSOR WITHOl1T AUTO PUMP SHUT OFF' <br />AUDIBLE AND VISUAL ALARMS <br />AUDIBLE AND VISUAL ALARMS <br />D 15. AUTOMATIC LEAK DETECTOR (3.0 GPH) WITHOIfT FLOW SHUT OFF <br />015. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) <br />D 16. ANNUAL INTEGRITY TEST (0.1 GPH) [117. DAILY VISUAL CHECK <br />D 16. ANNUAL INTEGRITY TEST (0.1 GPH) [117. DAILY VISUAL CHECK <br />VIII. DISPENSER CONTAINMENT <br />DISPENSER CONTAINMENT <br />D 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE D 4. DAILY VISUAL CHECK <br />DATE INSTALLED 468 <br />D 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS D 5. TRENCH LINER / MONITORING <br />® 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR D 6. NONE 469 <br />1997 <br />DISPENSER + AUDIBLE AND VISUAL ALARMS <br />IX. OWNER/OPERATOR SIGNATURE <br />I party that Ne infoimall p herein is true an accurate are beat of my knowledge. <br />SIGNATURE O RADATE <br />470 <br />If <br />4 23-0� <br />NAME OF NERIOPRATOR(print) <br />TITLE OF OWNERIOPERATOR 472 <br />Cynthia H. Madrid <br />General Manager, Retail Services <br />OFFICIAL USE ONLY Permit Number 473 1 Permit Approved 474 1 Permit Expiration Date 475 <br />UP FORM (1/2000 Version) 3 Formerly SWRCB Form B <br />SBC UST-B.doc <br />