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.11FIED PROGRAM CONSOLIDATED FOam/_i TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(CII«k a4 ma(apply . UNDERGROUND PIPING ASOVEGROUNO PIPING rPROTECTION ) pgE55URE ❑ 2. SUCTION ❑ 0. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 0.GRAVITY ❑ 1. SINGLE WALL ❑ S UNEOTRENCH ❑99 OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN R 2. DOUBLE WALL 5. UNKNOVM ❑ $. DOUBLEWALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BAPS STEEL ❑ B. FAP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE WI 10%METHANOL AND ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T.GALVANIZED STEEL ❑ 0. PLASTIC COMPATIBLE WITH CONTENTS 1195. UNKNOWN ❑ 0. PLASTIC COMPATIBLE WITH CONTENTS ❑ a. FLEUSI-E(MDPE) 13 99,OTHER ❑ a. FIBERGLASS ❑ B. FLEXIBLE(HDPE) 11$9. OTHER ❑ a. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ S. STEELWICOATING ❑ S. CATHOOICPROTECTION ❑ S. STEEL WI COATING ❑95. UNKNOWN NI.PIPING LEAK DETECTION(Ch«k 44 mat.p),lYI UNDERGROUND PIPING ABOVEGROUND PIPING SINGLEWALLPIPING SINGLE WALL PIPING - PRESSURIZED PIPING(Cna pk a4 N✓apply): PRESSURIZED PIPING(CTI«k ax that apply: ❑ 1. ELECTRONIC UNE LEAK OETECTOR 0.0 GPM TEST WTH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 0.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL SYSTEM FAILURE.AN D SYSTEM OISCONNECTION.AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY O 2 GPM TEST ❑ 2. MONTHLY 02 GPM TEST 11 0. ANNUAL INTEGRITY TEST(0.1 GPM) C1 3.ANNUAL INTEGRITY TEST III 1 GPM) ❑ a. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(G«k a4 mat appy): ❑ 5 DaILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST 101 GPM) ❑ O. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELFMONITORING ❑ T. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check a4m✓appll: ❑ 9. BIENNIAL INTEGRITY TEST(01 GPM) A ❑ B. GAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST IDA GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Gnat*M,not applyPRESSURIZED PIPING(Ch«k all that appy): 10 CONTINUOUS TURBINE SUMP SENSOR WITHAU018LEANOWSUALALARMS AND (C,,K*ane) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(FA«*ane) /j, a AUTO PUMP SHUT CFF WHEN A LEAK OCCURS 11a. AUTO PUMP SMUT OFF WHEN A LEAK OCCURS E AUTO PUMP SMUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM O-SCONNECTION ❑ E. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑E NO AUTO PUMP SMUT OFF ❑ 4. NO AUTO PUMP SMUT OFF ell AUTOMATIC LINE LEAK OETECTOR(0.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION 12 ANNUAL INTEGRITY TEST to 1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONGRAVITY SYSTEM: SVCTIONGRAVITY SYSTEM: ❑ 15. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 12. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(CTI«k a4 Mat pply) EMERGENCY GENERATORS ONLY(CTI«k a4 mat app"q ❑ 11. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 1a. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL MSUALALARMS ALARMS ❑ 15 AUTOMATIC LINE LEAK DETECTOR(0.0 GPM TEST)WITHOUT FLOW SMUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(0.0 GPM TEST) RESTRICT.0N1 ❑ 10.ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 1B. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 1T. DAILYVISUALCHECK I❑ 17. DAILY VISUAL CHECK WL DISPENSER CONTAINMENT DISPENSER CONTAINMENT1 FLOATMECHANISM THATSMUTS OFF SMEAR VALVE ❑ a. MILY VISUAL CHECK RATE INSTALLED ❑ 2.CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCMUNER/N INITORING 13 3,CONTINUOUS DISPENSER PAN SENSOR WITM AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑B. NONE DL OWNERIOPERATOR SIGNATURE I CaNfy Pal Pa' WTI qa0 M/avl is CMI FtW amnia to Pa East 01 M M aN!g . SiGNATUREOF PATE ✓ ,./� NAME Of010 ERA / TITI.E OF O T Fhi J�� 1 Pa It NM WIFwkX✓WI^^01 P✓mil APPnaN(f« Awe aaky) Pamil DrtagWbca/uaa 4M'1 BO 2� D O CUPAFORM(4199) (L � [� iv(ya`Apvy 1YIf11"GOri_/v�i FortneAy SWRCB Form