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All r <br /> JNII-IED PROGRAM CONSOLIDATED FORM <br /> TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI,PIPING CONSTRUCTION(Check all trim apply) Page _of <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE ®1.PRESSURE O 2 SUCTION 0 3.GRAVITY 458 01.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 <br /> CONSTRUCTION/ O 1.SINGLE WALL [13.LINED TRENCH O 99.OTHER 460 D 1.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER 0 2.DOUBLE WALL 0 95.UNKNOWN D 2.DOUBLE WALL O 99.OTHER <br /> MANUFACTURER Environ 461 MANUFACTURER_ 463 <br /> 01.BARE STEEL ❑fi.FRP COMPATIBLE w11110% METHANOL 01.BARE STEEL O 6.FRP COMPATIBLE Yll METHANOL <br /> D 2.STAINLESS STEEL 07 <br /> .GALVANIZED STEEL O UKNOWN 0 2. STAINLESS STEEL ❑7.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPA718 WI CONTENTS 0 99. OTHER 0 3. PLASTIC COMPATIBLE WI CONTENTS 0 B.FLEXIBLE(HOPE) O 99. OTHER <br /> 0 4.FIBERGLASS 198.FLEXIBLE(HOPE) 0 4. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL WICOATING O 9.CATHODIC PROTECTION 464 O 5. STEEL WICOATING 0 95.UNKNOWN 465 <br /> VII._PIPING LEAK DETECTION(check all that amply)(A description of the monitoring program shall be submitted to the Ideal agency.) __- <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check all Natapply): PRESSURIZED PIPING(Check all that apply): <br /> 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR 01. 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 /> 0 2. MONTHLY 0.2 GPH TEST O 2. MONTHLY 0.2 GPH TEST <br /> O 3. ANNUAL INTEGRITY TEST(0.1GPH) 0 3. ANNUAL INTEGRITY TEST(0.1GPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chasten Nal apply) <br /> 05. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY O5, DAILY VISUAL 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 /> D 7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELFMONITORING <br /> O9. BIENNIAL INTEGRITY TEST(BI GPH) GRAVITY FLOW(Check all that apply): <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) N yryli S{'CJCf t 4{nts (Checkone) <br /> ❑a. AUTO PUNS SHUT OFF WHEN A LEAK OCCURS,OrLLt[ j,5 to*,CCT' ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> ®b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM Ob AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> Oc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> ®11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR [111. AUTOMATIC LEAK DETECTOR <br /> RESTRICTION <br /> 0 12. ANNUAL INTEGRITY TEST ILL 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 SHUTOFF+AUDIBLE AND 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND <br /> VISUAL ALARMS VISUAL ALARMS <br /> 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> RESTRICTION <br /> 016. ANNUAL INTEGRITY TEST B.1 GPH) 016. ANNUAL INTEGRITY TEST(01 GPH) <br /> 017, DAILY VISUAL CHECK [117. DAILY VISUAL CHECK <br /> VIILDI§PENSEA CONTAINMENT <br /> DISPENSER 01. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE O 4.DAILY VISUAL CHECK <br /> CONTAINMENT <br /> DATEINSTALLED 466 02. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER I MONITORING <br /> 1997 <br /> 03. CO NUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ D 6.NONE 469 <br /> r DIBLE AND VISUAL ALARMS _ <br /> IX.OWNER/OPERATOA SIGNATURE *`+• " `"�A' =za �' ' <br /> I certify that lhe'elion provided he in is and accurate to the best of my knowledge. <br /> SIGNATU DATE 470 <br /> � � v3 <br /> NAME OWNER/OPRATOR(print) TITLE OF UVVNLRIOPERATOR 472 <br /> Randy Martin I Environmental Manager <br /> Permit Number(For local use only) 473 Permit Approved(For local use only) Permit Expiration Dale(For local use only) <br /> 475 <br /> UPCF(1/99 revised) Formerly SWRCB Form B <br />