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... IED PROGRAM CONSOLIDATED FOR <br /> TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Check an that apply) <br /> Page-of <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE ®1.PRESSURE D 2.SUCTION 0 3.GRAVITY 456 0 1.PRESSURE 0 2. SUCTION D 3.GRAVITY 459 <br /> CONSTRUCTION/ 0 1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 [11.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER 0 2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER Environ 461 MANUFACTURER_ 463 <br /> 01.BARE STEEL 0 6.FRP COMPATIBLE WI100% METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE W1i00%METHANOL <br /> 0 2.STAINLESS STEEL D 7.GALVANIZED STEEL 0 UKNOWN [12. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 03.PLASTIC COMPATIBLE W/CONTENTS 099. OTHER 03. PLASTIC COMPATIBLE W/CONTENTS 08.FLEXIBLE(HDPE) 099. OTHER <br /> 0 4.FIBERGLASS ®8.FLEXIBLE(HDPE) [14. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL WICOATING D 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING 0 95,UNKNOWN 465 <br /> VII.PIPING LEAK'DETECTION"(CryggMplL#etiWj)MAdsscnption of the monitoring program shall be submitted to the lout agency.)' <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 01. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR <br /> LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL <br /> ALARMS, ALARMS. <br /> [:12. MONTHLY 0.2 GPH TEST 0 2, MONTHLY 0.2 GPH TEST <br /> 03. ANNUAL INTEGRITY TEST(0.1GPH) 03. ANNUAL INTEGRITY TEST(0.1GPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Ch%kall Natapply) <br /> 05. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY 05. DAILYVISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 06. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELFMONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.11 GPH) GRAVITY FLOW(Check all that appy): <br /> O8. DAILY VISUAL MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br /> (Check one) (Checkers) <br /> Da. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Oa AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> Ob. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHU3 r OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> 0c. NOAUTO PUMP SHUT OFF Om NOAUTO PUMP SHUT OFF <br /> 011. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR ❑it. AUTOMATIC LEAK DETECTOR <br /> RESTRICTION <br /> 012. ANNUAL INTEGRITY TEST(0.1 GPH) 012. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTIONIGRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND <br /> VISUALALARMS VISUALALARMS <br /> 015.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOLIff FLOW SHUT OFF OR 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> RESTRICTION <br /> 016. ANNUAL INTEGRITY TEST(0.1 GPH) 016. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 017. DAILY VISUAL CHECK D17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER Ell. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK <br /> CONTAINMENT <br /> DATE INSTALLED 02. CONTINUOUS DISPENSER PAN SENSOR t AUDIBLE AND VISUAL ALARMS D S.TRENCH UNER I MONITORING <br /> 2003 03. TINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER• 0 6.NONE 469 <br /> CO <br /> AND VISUAL ALARMS <br /> IX.OW NERIOPERATOR.SIGNATURE <br /> certify Nat the i rmain is rate to the Deal of my krwwledge. <br /> SIGNATU ROPE T DATE 97 470 <br /> NAME OF NERIOPRATOR(Prirlp TITLE OF'OVVNEFUOPERATOR 472 <br /> Randy Martin Environmental Manager <br /> Permit Number(For local use only) 473 Permit Approved(For local use only) Permit Expiration Date(For local use only) <br /> 475 <br /> UPCF(1/99 revised) Formerly SWRCB Form B <br />