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IFIED PROGRAM CONSOLIDATED FO TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check an that apply) Page 5 of 5 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 01.PRESSURE 02.SUCTION 13.GRAVITY 456 D 1.PRESSURE [12. SUCTION ❑3.GRAVITY 469 CONSTRUCTION/ ❑1.SINGLE WALL 0 3.LINED TRENCH D 99.OTHER 460 ❑1.SINGLE WALL 0 95.UNKNOWN 462 MANUFACTURER ®2.DOUBLE WALL D 95.UNKNOWN [12.DOUBLE WALL 0 99.OTHER MANUFACTURER 461 MANUFACTURER 463 01.BARE STEEL ®6.FRP COMPATIBLE w/100% METHANOL 01.BARE STEEL [16.FRP COMPATIBLE WI700%METHANOL D 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN [12. STAINLESS STEEL [17.GALVANIZED STEEL 03.PLASTIC COMPATIBLE W/CONTENTS 099, OTHER 03. PLASTIC COMPATIBLE W/CONTENTS 08.FLEXIBLE(HDPE) 099. OTHER [14.FIBERGLASS D B.FLEXIBLE(HDPE) [14 FIBERGLASS 0 9.CATHODIC PROTECTION ❑5.STEEL WICOATING ❑9.CATHODIC PROTECTION 464 ❑5. STEEL W/COATING ❑95.UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that spiel , A description of the monitoring program sha1168submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that ecply): PRESSURIZED PIPING(Check all that apply): ❑1. ELECTRONIC LINE LEAKDETECTOR 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 LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION,AUDIBLE AND VISUAL LLEAAKK,,SYSTEM FAILURE,AND SYSTEM DISCONNECTION,AUDIBLE AND VISUAL ALARMS. [:12. MONTHLY 0.2 GPH TEST [12. MONTHLY 0.2 GPH TEST 03. ANNUAL INTEGRITY TEST(O.1GPH) 03. ANNUAL INTEGRITY TEST(0.1GPH) 04. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all Matapply) 1-15. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY D5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) D 7. SELF MONITORING SAFE SUCTION SYSTEMS(NOVALVES IN BELOW GROUND PIPING): GRAVITY FLOW D 7. SELF MONITORING 09, BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Cheek all that apply): DB. DAILY VISUAL MONITORING [19. 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 (Check one) (Check one) Ms. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Da AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM Ob DISCONNECTION AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION Dc. NO AUTO PUMP SHUT OFF me NO AUTO PUMP SHUT OFF 011. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR 011, AUTOMATIC LEAK DETECTOR RESTRICTION [112, ANNUAL INTEGRITY TEST(0.1 GPH) 012. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM D13, CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS D13. CONTINUOUS SUMP SENSOR+AUDIBLE ANDVISUALALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check aft that apply) D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND 014. V NTINUOUSSUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUALALARMS [115. AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR 015. AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION 016. ANNUAL INTEGRITY TEST(0.1 GPH) 016, ANNUAL INTEGRITY TEST(0.1 GPH) D17, DAILY VISUAL CHECK 017. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER 01. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ®4.DAILY VISUAL CHECK CONTAINMENT DATEINSTALLED 466 D2. CONTINUOUS DISPENSER PAN SENSOR,AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER I MONITORING 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ O6.NONE 469 AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I certify that the Infometion Provided herein is true and accurate to the best of my knowledge. SIG URE OF ER/OPEPSATOR DATE 470 3117100 NA O R/OPRATOR(pant) TITLE OF OWNER/OPERATOR 472 Zai a Gianino of RHL Design Grou , Inc. Agent for Tosco Permit Number(For local use only) 473 Permit Approved(Far local use only) Permit Eapimtion Dale(For local use only) 475 UPCF(1/99 revised) Formerly SWRCB Form B