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e� *IED PROGRAM CONSOLIDATED FOR TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all that apply) rage _ of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE N 1.PRESSURE 0 2.SUCTION D 3.GRAVITY 458 0 1.PRESSURE [12 SUCTION 0 3.GRAVITY 459 CONSTRUCTION I 01.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 0 1.SINGLE WALL 0 95.UNKNOWN 462 MANUFACTURER S 2.DOUBLE WALL [195.UNKNOWN [12.DOUBLE WALL 0 99.OTHER MANUFACTURER Environ 461 MANUFACTURER_ 463 01.BARE STEEL 0 6.FRP COMPATIBLE w/70076 METHANOL [11.BARE STEEL 0 6.FRP COMPATIBLE wI100%MErHAN01. D 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL 03.PLASTIC COMPATIBLE W/CONTENTS 099. OTHER 03. PLASTIC COMPATIBLE W/CONTENTS 08.FLEXIBLE(HDPE) 099. OTHER N 4.FIBERGLASS S 8.FLEXIBLE(HDPE) 0 4. FIBERGLASS 0 9.CATHODIC PROTECTION 0 5.STEEL WICOATING [19.CATHODIC PROTECTION 464 1 D 5. STEEL W/COATING 0 95.UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that apply)(A description of the monitoring program shall as submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE ANDVISUAL LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION«AUDIBLE AND VISUAL ALARMS. ALARMS. 02. MONTHLY 0.2 GPH TEST 02. MONTHLY 0.2 GPH TEST 03. ANNUAL INTEGRITY TEST(0.1GPH) 03. ANNUAL INTEGRITY TEST(O.IGPH) 04. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all Nazapply) 05. DAILY VISUAL MONITORING OF PUMPING SYSTEM TRIENNIAL PIPING INTEGRITY 05. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 06. TRIENNIAL INTEGRITY TEST(0.1 GPH) 07, SELFMONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELF MONITORING 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): [18. DAILY VISUAL MONITORING 09. 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 ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Chad ane) (Chock are) Da. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Da AUTO PUMP SHUT OFF WHEN A LEAK OCCURS St. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Uc. NOAUTO PUMP SHUT OFF Dc NO AUTO PUMP SHUT OFF 511. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR 011, AUTOMATIC LEAK DETECTOR RESTRICTION 512. ANNUAL INTEGRITY TEST(0.1 GPH) 012. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUGTIONIGRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR*AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) D14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND 014. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF+AUDIBLE AND VISUALALARMS VISUALALARMS 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION 016. ANNUAL INTEGRITY TEST(0.1 GPH) 016. ANNUAL INTEGRITY TEST(0.1 GPH) 0 17. DAILY VISUAL CHECK D 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER 01. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04,DAILY VISUAL CHECK CONTAINMENT DATEINSTALLED 46 02. CONTINUOUS DISPENSER PAN SENSOR,AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER I MONITORING 2003 N3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ 0 6.NONE 469 AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE' I certify that the in at i provided in is I end accurate to the best of my knowledge. SIGNATUR F OP DATE 470 NAME OF NER/OPRATOR(print) TITLE F 0wolIEWOPERATOR 472 Rand Martin Environmental Manager Permit Number(For local use only) 473 Pennil Approved(For local use only) Penn"Expiration Date(For local use only) 475 UPCF(1/99 revised) Formerly SV/RCB Form B