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MFaY-11 -2010 11 :24 RM P . 07 UP ED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE Z Alp[ N ICTI N hmk a01h °E UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE PRESSURE C 2.SUCTION ❑3.GRAVITY 451 ❑1,PRESSURE 0 2. SUCTION ❑J.GRAVITY 419 CONSTRUCTION ❑I.SINGLE WALL ❑3.LINED TRENCH ❑-OTHER 40 Q 1.SINGLE WALL ❑95.UNKNOWN d6a MANUFACTURERDOUBLE WALL L7 95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER MANUFACTURER H3 ❑I.BARE STEEL 0 6,FRP COMPATIBLE w/IMM NTETHANOL [31.BARE STEEL ❑6,PRP COMPATIBLE wg90aL htBrxANOL ❑2.STAIMR.SS 9'IEEL 0 7.GALVANIZED STEF.I. ❑Unknown 0 2. STAINLESS STEEL ❑7.GALVANIZED STEEL Q 3.PLASTIC COMPATIBLE W/CONTENTS 0 99. Other Q 3. PLASTIC COMPATIBLE W1 CONTENTS ❑S,FLEXIBLE(HDPE) [199 OTHER D4-FIBERGLASS Q S.FLEXIBLE(HDPE) 0 4. FIBERGLASS 0 9,CATHODIC PROTECTION Id 5.STEEL WA;OATNC) 0 9,CATHODIC PROTECTION deo ❑5. STEEL W/COATNO [193.UNKNOWN 461 VII.PIPINGLEAK DF..TEC[I NcdallM ADae. aen oEM.mn ilain ro am aM1dlae.hml romelp.n• UNDERGROUND PIPMO ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL,PIPING °67 PRESSURIZED PIPING(Chan JI dme PIY) PRESSURIZED PIPING(Cheek all Mn wpb; ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST_W TW AUTO PUMP SHUT ❑1, ELECTRONIC LINE LEAK DP.TECTOR 30 OPH TEST YI $AUTO PUMP OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION- SHUT OFF AUDIBLE AND VISUAL ALARMS FAILURE.AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. 0 2. MONTHLY 0.1 GPH TEST Q 2 MONTHLY 0 2 GEN TEST ❑3.ANNUAL INMORITY TEST(0,IDPH) ❑3.ANNUAL INTEGRITY TEST(0,IDPH) ❑9. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMA CONVENTIONAL SUCTION SYSTEMS(Cbak d1 Mat gp1Y) Q S.DAILY VISUAL MONITORING OF PUMPING SYSTEM,TRIENNIAL PIPING C3 5. DAILY VISUAL MONITORING OF PIPNO AND PUMPING SYSTEM INTEGRITY TEST(0.I GPH) SAFE SUCTION SYSTEMS(NO VALUES N BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0,L OPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ORAVITYrLOW [3 79 SELF MONITORING Cl 9.BIENNIAL INTEGRITY TEST(0.1 OPH) GRAVrrY FLOW(Chak Ni tbet 1111). Q S. DAILY VISUAL MONITORING Q 9. BIENNIAL INTEGRITY TEST(0.1 OPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(nah W MM Pppl'). PRESSURIZED PIPINOKTrok au lhataPP10 t0. CONTINUOUS TURBINE SUMP SENSOR WIT$AUDIBLE AND VISUAL 10. ALARMS TURBC�dINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(chak ee.) AUTO PUMP SHLT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b. AUTO RUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b DISCONNECTION Ou OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c. NO AUTO PUMP SHUT OFF ❑P NO AUTO PUMP SHUT OFF ❑11. AUTOMATIC LINF LEAK DETECTOR(9.0 GPH TEST)WITTY FLOW SHUT ❑11. AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONtORAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑13. CONTINUOUS SUMP SFNSOR+AUDIBLE AND VISUAL ALARMS C3 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS EMEIIGENCY GENERATORS ONLY(Check Ml that w01Y) EMERGENCY GENERATORS ON LY(click dl d 1*0 014. CONTNUOUS SLMP SENSOR WITHOUT AL TO PUMP SHUT OFF• [3 14. CONTINUOUS SUMP SENSOR WIIHSSUT AU TO PUMP SHUT OFF' AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS Q 15. AUTOMATIC LINE I.PAK DETECTOR(3 0 OPH TEST)WITHOU PLOW ❑13. AUTOMATIC LINE LEAK DETECTOR(10 OPH TEST) SHUT OFF OR RESTRICTION (:316.ANNUAL INTEGRITY TEST(0.1 OPH) C)16.ANNUAL INTEGRITY TERT(0.1 GPH) Q 17. DAILY VISUAL CHECK 1 ❑17. DAILY VISUAL CHECK VIIL DISPENSER CONTAINMENT DISPENSER CONTAI TMENt 01.FLOAT MECHANISM THAT SHUTS OFPSHE.AR VALVE ❑4.DAILY VISUAL CHECK DA�J�E INSTALLED [3 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL.ALARMS S.TRENCH LINER/MONITORING [3 3.CONTINUOUS DISPENSER E AND VISUAL ALAWRN9 AUTO SHUT OFF FOR Q 6,NONE •f((ur d 60 I DISP IX.OWNgWOPERATOR SIGNATURE 1c pEY e,M 6n IMRreMlon pmvleee hewn ld n+re�xtletebN Mebdel Of my lmaW,WA d 10 A URE OF 'OP DATE�`j 3 5^ 3_ N AEOF 0V ERRg_ 410R( )v �, 4'!t TILE OP OWNER/OP R TOR O5 Permit Numbd orlaM uM OR 1 dl] P lappmved(Por pw uxe Y) .',tEeoinHen Dne(I.,ad e•e odY) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form A