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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE T�*T�r� TANK VL PIPING CONSTRUCTION(check dl mins TANK PAGE 2 UNDERGROUND PIPUJG Page 2.f 6 SYSTEM TYPE 0 1,PRESSURE 0 I.SUCTION 0 3.GRAVITY 458ABOVEGROUND PIPMG coNSTRucnoN ❑L ❑3 .LINED TRENCH 1199.SINGLE WALL 0 1.PRESSURE 0 2. SUCTION 0 3.OTHER 460 459 MANUFACTURER 0 2.DOABLE WALL 0 95.UNKNOWN ❑1.SINGLE WALL GRAVITY 0 95.UNKNOWN 2DOUBLE WALL 462 MANUFACTURER AO Smi ,th �99.OTHER ❑I.BARE STEEL ❑6.FRP COMPATIBLE wh461 MANUFACTURER op% METHArvo1 463 O 2.STAINLESS STEEL 0 L BARE STEEL [16.FRP COMPATIBLE W/I WA METHAN 0 7.GALVANIZED STEEL 0 Unknown 0 2. STAINLESS STEEL OL 0 3.PLASTIC COMPATIBLE W/CONTENTS 1:199. Other ❑3 ❑7.GALVANIZED STEEL ❑8.FLEXIBLE(HDPE) 0 4.FIBERGLASS . PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPE) ❑99 OTHER [14. FIBERGLASS [15.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 Vil.PIPINescdD d ❑9CATHODIC ATHODIC.P ROTECTION G LEAK DETEC5. STEEL W/COATING 95 UNKNOWN UNDERGROUNDPPMG ( catePIr)(Adb , tnonhodn ullbeaubminMomebwlegm ) 465 rMONTHLY INGLE WALL PIPING ABOVEGROUND PIPING 466 i SINGLE WALL PIPING IPMG(Check all that apply): 467 IC LME LEAK DEFECTOR 3.0 GPH TEST PRESSURIZED PIPING(Cheek ell that apply): EAK,SYSTEM FAILURE,AND SYSTEM DIWSCONNECTION+P SNl7i i. ELECTRONIC LME LEAK DETECTOR 3.0 GPH TEST Wr pU7p PUMP ND VISUALALARMS SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ 01 GPH TEST AUDIBLE AND VISUAL ALARMS, . L INTEGRI71'TEST(O.IGPFi) 0 2. MONTHLY 01 GPH TEST 3.ANNUAL INTEGRITY TEST(0.1GPH) CONVENTIONAL SUCTION SYSTEMS 0 4, DAILY VISUAL CHECK [15.DAILY VISUAL MONITORING OF PUMPING SYSTEM+ CONVENTIONAL SUCTION SYSTEMS(Check all that apply) INTEGRITY TEST(0.1 GPH) TRIENNIAL PIPING 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES M BELOW GROUND PIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) 0 7.SELF MONITORING GRAVITY FLOW SAFE SUCTION SYSTEMS(NO VALVES M BELOW GROUND PIPING): 0 7, SELF MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.t GPH) GRAVITY FLOW(Check all tim apply): 118- DAILY VISUAL MONITORING SECONDARILY CONTAINED PIPING ❑9, BIENNIAL INTEGRITY TEST(0.1 GPH) PRESSURIZED PIPING(Check all that apply): SECONDARILY CONTAINED PIPING 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL PRESSURIZED PIPING(Chxk all that apply): ALARMS AND(Chat one) t0, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 03' AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ALARMS AND(Check one) 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILUREAND SYSTEM 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS DISCONNECTION 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0c. NO AUTO PUMP SHUT OFF DISCONNECTION ®11. AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT Oc NO AUTO PUMP SHUT OFF OFF OR RESTRICTION 0 11. AUTOMATIC LEAK DETECTOR IN 12. ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all mm apvly) 0 14. CONTINUOUS SUMP SENSOR EMERGENCY GENERATORS ONLY(Check ell that apply) AUDIBLE AND VISUAL ALARMS 1 A�PSP SHUT OFF• El 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 0 I5. AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST)WITH�O 7 FLOW AUDIBLE AND VISUAL ALpRf,15 SHUT OFF OR RESTRICTION 0 15. AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST) 0 16,ANNUAL INTEGRITY TEST(0.1 GPH) 0 17. DAILY VISUAL CHECK 0 16'ANNUAL INTEGRITY TEST(0.1 GPH) 017. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 0 I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INSTALLED 46s ®2,CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 S.DAILY VISUAL CHECK 9/28/90 0 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑5.TRENCH LINER/MONITORING DISPENSER+AUDIBLE AND VISUAL ALARMS 0 6.NONE 469 IX.OWNER/OPERATOR SIGNATURE I certify that the infarmaibn pmvidM herein is we and accurate to the best ofmy krpwledge. SIGNATURE OF0 TOR N.9Q,LrE7(I DATE NAME OF OWNER/OP TOR(pont) 5/30/02 470 Chevron Products Com an /D.R. LERI TITLE OF OWNER OPERATOR Permit Number(For baluu only) 413 Retail ESH Specialist 47' Pnsnh APWovcd(Farbwl use only) P.,,Ea sbn Date beat use only)l Pira u475 1)PCF(1/99 reviged) 1'7d