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USIED PROGRAM CONSOLIDATED FORMSTANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 Page 5 or 5 VI.PIPING CONSTRUCTION(Check all that apply) ABOVEGROUND PIPING UNDERGROUND PIPING459 SYSTEMTYPE S 1,PRESSURE [12,SUCTION [13.GRAVITY 456 [11.PRESSURE ❑2. SUCTION[3 95.UNKNOW❑N3.GRAVITY 461 CONSTRUCTION I [j1.SINGLE WALL [13.LINED TRENCH ❑99.OTHER 466 O 1,1.SINGLE WALL DOUBE WALL [:199.OTHER MANUFACTURER 0 2,DOUBLE WALL [195.UNKNOWN 461 MANUFACTURER 463 MANUFACTURER 1 BARE STEEL ❑6.FRP COMPATIBLE wIt06°4 MERiANot ❑1.BARE STEEL 0 B.FRP COMPATIBLE w1700% METHANOL 7 GALVANIZED STEEL [12.STAINLESS STEEL [17.GALVANIZED STEEL NO HER OWN 2. STAINLESS STEEL ❑3. PLAS IC COMPATIBLE WI CONTENTS ❑8.FLEXIBLE(HDPE) [199, OTHER [13.PLASTIC COMPATIBLE WI CONTENTS [199. ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION FLEXIBLE HDPE ❑95.UNKNOWN ass [14.FIBERGLASS [18. ( ) 464 [15. STEEL WICOATING ❑5.STEEL WICOATING ❑9.CATHODIC PROTECTION VII. PIPINO.LEAK iDETECTION(Check all that apply)(A description of the monitorin' progrem shall tie su5mlued to the local agency.4 ABOVEGROUND PIPING UNDERGROUND PIPING SINGLE WALL PIPING 467 SINGLE WALL PIPING I PRESSURIZED PIPING(Check all Nat apply& RESSURIZED PIPING(Check ell that apply): ❑1. ELECTRONIC LINE LEAK DETECTOR3,0 GPH TEST'LIITH AUTO PUMP S1 �EAKTECTOR 10 GPH TO S�BTIEM FAILURE,ANC LINE LEAK TD BYS EM DISCONNECTION3T WITH AUAUDIBETO PANDUVISUALOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE ANALARMS.ALARMS. 2, MONTHLY 0.2 GPH TEST [12. MONTHLY 0,2 GPH TEST ❑3. ANNUAL INTEGRITY TEST(O,iGPH) ❑3, ANNUAL INTEGRITY TEST(OAGPH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY 05, DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) ❑6, TRIENNIAL INTEGRITY TEST(0,1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 07. SELFMONITORING ❑7, SELFMONITORING GRAVITY FLOW GRAVITY FLOW(Check all that apply): ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) ❑8, 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 WWITH AUDIBLE AND VISUAL ALARMS AND 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND eck one) (Check one) ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Sal AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [3b, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM b OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑c NOAUTO PUMP SHUTOFF ❑c. NOAUTOPUMPSHUTOFF 011. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR 011, AUTOMATIC LEAK DETECTOR RESTRICTION [312. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12, ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONIGRAVITY SYSTEM SUCTIONIGRAVITY SYSTEM ❑13, CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS C3 13, CONTINUOUS EMERUMP GENCY GENERATORS VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) ❑14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND [3 M. VCONTINUOUS SUALALARMS MP SENSOR WIT OU AUTO PUMP SHUT OFF*AUDIBLE AND VISUALALARMS [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOLIJ FLOW SHUT OFF OR ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION [116, ANNUAL INTEGRITY TEST(0.1 GPH) ❑16. ANNUAL INTEGRITY TEST(01 GPH) ❑17, DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VIII:DISPENSER CONTAINMENT DISPENSER 0 4.DAILY VISUAL CHECK ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE CONTAINMENT DATE INSTALLED ase ❑2. CONTINUOUS DISPENSER PAN SENSOR«AUDIBLE AND VISUAL ALARMS ❑ .TRENCH LINER(MONITORING 469 ❑3. CONTINUOUS IS DISPENSER SENSOR WITH AUTO SHUT OFF FOR DISPENSER 6NONE AUDIS '...- IX.OWNER/OPERATOR8IGNATURE I codify that the information provided herein is true and accurate to the best of my knowledge. 470 DATE SIGN TORE OF OWNED R/O?ARATOR 3�17/00 472 ME TITLE OF OWNER/OPERATOR ME O R/OPof (print) Za a Glanino of RHL Desi n Grou r In Agent for ToscoC. Permit Expiration Date(For lural use only) Permit Number(For local use only) 473 Permit Approveo(For local use only) 475 mr Formerly SWRCB Form B UPCF(1/99 revised)