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1 LIWIED PROGRAM CONSOLIDATED FORNM TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 ,. VI. PIPING CONSTRUCTION iCheck all MatappM Page 7 of 5 UNDERGROUND PIPING ABOVEGROUND PIPING S459 YSTEM TYPE ®1.PRESSURE [12.SUCTION ❑3.GRAVITY 456 ❑1,PRESSURE ❑2. SUCTION ❑3.GRAVITY 461 CONSTRUCTION I [11.SINGLE WALL ❑3.LINEDTRENCH ❑99.OTHER 460 ❑1.SINGLE WALL [195.UNKNOWN MANUFACTURER ®Z DOUBLE WALL [195.UNKNOWN ❑2.DOUBLE WALL [199.OTHER 463 MANUFACTURER 461 MANUFACTURER ❑1.BARE STEEL ®6.FRP COMPATIBLE wlt00u METHANOL ❑1.BARE STEEL [16.FRP COMPATIBLE WI100u METHANOL [12.STAINLESS STEEL [17.GALVANIZED STEEL ❑UKNOWN [12. STAINLESS STEEL [17.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE WI CONTENTS ❑99. OTHER [13. PLASTIC COMPATIBLE WI CONTENTS ❑a.FLEXIBLE(HDPE) [199. OTHER [14, FIBERGLASS ❑9.CATHODIC PROTECTION ❑4.FIBERGLASS [18,FLEXIBLE(HDPE) 485 ❑5.STEEL WICOATING [19.CATHODIC PROTECTION 464 [15. STEEL WICOATING ❑95.UNKNOWN VIC'PIPING LEAK DETECTION Checkallihal appy) A descriMian of the monitoring program shalAIBOsubmitted to VEGROUNDePIPINGlocal agency'1 UNDERGROUND PIPING 467 SINGLE WALL PIPING 466 SINGLE WALL PIPING rLEAK D PIPING(Check all Nat apply}. PRESSURIZED PIPING(Check au that apply): LECTRONIC LINE LEAK DETECTOR 3.0 GPH TE YSTEM FAILURE,AND SYS EM DISCONNECTION+AUD BLE ANOO VISUALFOR 1' LEAK,S STEM FAILURE,AND SYS EM DISCONNECTION ST WITH AUAUUDIB EPAND VISHUT SUAL FF OR . ALARMS. LY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPHTEST . LINTEGPITY TEST(O.1GPH1 03. ANNUAL INTEGRITY TEST(0.1GPH) [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) AL INTEGRITY TEST(0.1 GPIH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPINGp. SAFE SUCTION ISYSTEMS(No VALVES IN BELOW GROUND PIPING): ❑7. SELF MONITORING [17, SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check all that apply): 09. BIENNIAL INTEGRITY TEST 10.1 GPH) []6. DAILY VISUAL MONITORING [19. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all mat apply): PRESSURIZED PIPING(Check an that apply): 10. CONTINUOUS TURBINE SUMP SENSORWWN�AUDIBLE AND VISUAL ALARMS AND 10. (Chheck one) USTURBINE SUMP SENSORWITH AUDIBLEANDVISUALALARMS AN (Check one) ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ®a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [3b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 6 AUTO DISCONNECTION OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION [3c. NO AUTO PUMP SHUT OFF Dc NO AUTO PUMP SHUT OFF ®11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR [111, AUTOMATIC LEAK DETECTOR RESTRICTION ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) SSUCTIONIGRAVITY SYSTEM UCTIONIGRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR-AUDIBLE ANDVISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR-AUDIBLE ANDVISUALALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) [:114. CONTINUOUS SUMP SENSOR WTTHOIJJ AUTO PUMP SHUT OFF-AUDIBLE AND El 14. VCONTINUOUS ISUALALARMS MP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUALALARMS ❑15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR [3 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) 116. ANNUAL INTEGRITY TEST(0.1 GPH) 017, DAILY VISUAL CHECK ❑17 DAILY VISUAL CHECK h 'Hr+a. VIII':DISPENSER CONTAINMENT ri;ql ®4 DAILY VISUAL CHECK DISPENSER 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE CONTAINMENT DATEINSTALLED 468 I]2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUALALARMS ❑5TRENCH LINERI MONITORING as9 03 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ p6 NONE ^r AUDIBLE AND VISUAL ALARMS --§ U(;OWNERIOPERATOR SIGNATURE 4f ��i .z T 1,se I cert fy that the'mrormallon provided herein is true and accurate to the best of my knowledge. 470 SIG URE OF ERIOPERATOR DATE 3/17/00 472 NA OVIREctiaphtA I OR(print) TITLE OF OWNEWOPERATOR Zai a Gianino of RHL Design Grow , inc. Agent for Tosco 477 Permit Approved(For local u e only) Permit Explralion Date(For local use only) pertnil Numbtt(For local use only) 47 Formerly SWRCB Form B UPCF(1/99 revised)