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PROGRAM CONSOLIDATED UNDERGROUND STORAGE TANKS - TANK PAGE 2 UNDERGROUND PIPING SYSTEM TYPE ® L PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION ❑ I. SINGLE WALL ❑ 3. LINED TRENCH ❑ 99. OTHER MANUFACTURER ® 2. DOUBLE WALL ❑ 95. UNKNOWN MANUFACTURER ENVIRON ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE w/l00% METHANOL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL I ❑ Unknown ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS ❑ 99. Other ❑ 4. FIBERGLASS ® 8. FLEXIBLE (HDPE) ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464 VII. PIPING LEAK DETECTION !Cluck al TANK f Check all flute Page of ABOVEGROUND PIPING 4M ❑ 1. PRESSURE [12. SUCTION ❑ 3. GRAVITY 459 469 [11. SINGLE WALL ❑ 95. UNKNOWN 462 [12. DOUBLE WALL [199. OTHER 461 MANUFACTURER ❑ 1. BARE STEEL ❑ 2. STAINLESS STEEL ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS ❑ 4. FIBERGLASS ❑ 5. STEEL W/COATING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Checkal] tlutapply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST W11' AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (O.1GPH) CONVENTIONAL SUCTION SYSTEMS ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+ TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): ❑ 7. SELF MONITORING GRAVITY FLOW ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check a that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WIT} AUDIBLE AND VISUAL ALARMS AND (Cbeckone) ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEMFAILURE AND SYSTEM DISCONNECTION ❑c. NO AUTO PUMP SHUT OFF [ILL AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WIT FLOW SHUT OFF OR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check a110W apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 17. DAILY VISUAL CHECK 463 [16. FRP COMPATIBLE W/lO METHANOL [17. GALVANIZED STEEL ❑ S. FLEXIBLE (HDPE) ❑ 99. OTHER ❑ 9. CATHODIC PROTECTION ❑ 95. UNKNOWN 465 SINGLE WALL PIPING PRESSURIZED PIPING (Check ell that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTI AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Cheek all that apply) ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING GRAVITY FLOW (Cheekall dutapply): ❑ 8. DAILY VISUAL MONITORING ❑ 9. 13MNNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all out apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEMFAILURE AND SYSTEM DISCONNECTION ❑c NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check ell thatepply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 17. DAILY VISUAL CHECK VID. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ® 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED w ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+ AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER /MONITORING 1997 ❑ 3. CONTINUOUS DISPENSER PAN SENSOR W AUTO SHUT OFF FOR D 6. NONE 469 DISPENSER + AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE 467 I ea* that the mfonpa6on providedherem u true NAME OF OWNER/OPRATOR (pnnt) 10/2N /0 MANAGER UPCF (1/99 revised) Formerly SWRCB Form B