Laserfiche WebLink
j� <br /> IFIED PROGRAM CONSOLIDATED F <br /> ',L'c� a2 � I TANK <br /> UNDERGROUND STORAGE TANKS TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(check ag mat y Page 2 of 6 <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 0 1.PRESSURE [12.SUCTION 0 3.GRAVITY 458 0 1.PRESSURE 0 2. SUCTION O 3.GRAVITY 459 <br /> CONSTRUCTION ❑1.SINGLE WALL [13.LINED TRENCH [199.OTHER 460 [11.SINGLE WALL [:195.UNKNOWN 462 <br /> MANUFACTURER ®2.DOUBLE WALL 0 95.UNKNOWN O 2.DOUBLE WALL [199.OTHER <br /> MANUFACTURER AO Smith 461 MANUFACTURER_ 463 <br /> 0 L BARE STEEL [16.FRP COMPATIBLE wh1 METHANOL 0 L BARE STEEL [16.FRP COMPATIBLE w/IOOX METHANOL <br /> 0 2.STAINLESS STEEL [17.GALVANIZED STEEL O Unknown 0 2. STAINLESS STEEL [17.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPATIBLE W/CONTENTS [199. Offer [13. PLASTIC COMPATIBLE W/CONTENTS [18.FLEXIBLE(HDPE) 0 99. OTHER <br /> 0 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) [14. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> [15.STEEL W/COATING [19.CATHODIC PROTECTION 4" [15. STEEL W/COATING [195.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION(Check all that appy)(A dant ion of 0m taonitrning pmgmm slap 6e submitted tome local arc . <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Ch all that apply): PRESSURIZED PIPING(Chock all that apply): <br /> ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT [11. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> 0 2.MONTHLY 0.2 GPH TEST 0 2. MONTHLY 0.2 GPH TEST <br /> 0 3.ANNUAL INTEGRITY TEST(O.1GPH) [13.ANNUAL INTEGRITY TEST(O.IGPH) <br /> [14. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that aryly) <br /> 0 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(RI GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUND PIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 0 7. SELF MONITORING <br /> 0 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): <br /> 0 8. DAILY VISUAL MONITORING <br /> 0 9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Cheek all dna appy): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check ora) ALARMS AND(Check aha) <br /> 0 a. AUTO POMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> ®b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> 0c. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 0 11 AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVrrY 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 mat rply) <br /> [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW <br /> SHUT OFF OR RESTRICTION 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 017. DAILY VISUAL CHECK 017. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT [11.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [15.TRENCH LINER/MONITORING <br /> 1/1/96 0 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR [16.NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> ,banaI certify dm the mtormmio 'n and accuratc w the l at of my knowledge. <br /> SIGNATURE OF ER DATE 470 <br /> fD X LrE9�{ 6/3/02 <br /> NAME OF OWNER/OP TOR(print) TITLE OF OWNER/OPERATOR 472 <br /> Chevron Products Co an /D.R.LERI Retail ESH Specialist <br /> Pcond Number(For Inial Tae only) 473 Pem+it Approved(For local use only) Permit Eapiewon Daze(For local use only) 475 <br /> UPCF(1/99 revised) 174 Formerly SWRCB Form <br />