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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS TANK PAGE 2 TANK VI.PIPINGCONSTRUCTIOIJ(Check all meta 1) UNDE&GROUND PIPING Page 2 or 6 SYSTEM TYPG ® I.PRESSURE ❑2.SUCTION ABOVEGROUND PIPING CONSTRUCTION W 1,SINGLE WALL 3.999,OTHER OTHER 4R 460 ❑1.PRESSURE ❑2. SUCTION ❑3.LINED TRENCH � 60 0 3.GRAVITY 459 MANUFACTUR ❑95. ER ®2.DOUBLE WALL 1 SINGLE WALL ❑95.UNKNOWN UNKNOWN ❑2DOUBLE WALL 462 . MANUFACTURER AO Smith ❑99.OTHER ❑ 1.BARE STEEL 461 MANUFACTURER ❑b.FRP COMPATIBLE wp00'6 METHANOL ❑1.BARE STEEL -- 463 O 2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑Unknown ❑6.FRP COMPATIBLE W/100A METHANOL ❑3.PLASTIC COMPATIBLE W/CONTENTS 2- STAINLESS STEEL [17.GALVANIZED STEEL ®4.FIBERGLASS118. ❑99. 011ier ❑3. PLASTIC COMPATIBLE W/CONTENTS �8.FLEXIBLE(HDPE) ❑8.FLEXIBLE(HDPE) 1199. OTHER ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 464 ❑4• FIBERGLASS 119.CATHODIC PROTECTION ATING❑5. STEEL W/CO VII.PIPING LEAK DETECTION(Cheek all theta I)(A descriW/CO themm�hodn -95.UNKNOWN 465 UNDERGROUND""NG ram shall be aobmiued to the bcal agency.) SINGLE WALL PIPING ABOVEGROUND PIPING °661 PRESSURIZED PIPING(Check ell shat apply): SINGLE WALL PIPING 467 ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP$CRIT PRESSURIZED PIPING(Chack all that apply): OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ 111. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP AUDIBLE AND VISUAL ALARMS. SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ ❑2.MONTHLY 0.2 GPH TEST AUDIBLE AND VISUAL ALARMS, ❑3.ANNUAL INTEGRITY TEST(0.IGPH) Ef 2. MONTHLY 0.2 GPH TEST ❑l3.ANNUAL INTEGRITY TEST(0.IGPH) CONVENTIONAL SUCTION SYSTEMS 04. DAILY VISUAL CHECK (15.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL CONVENTIONAL SUCTION SYSTEMS(Check all that apply) INTEGRITY TEST(0.1 GPH) PIPING' Q 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUND PIPING): [17.SELF MONITORING 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑9.BIENNIAL INTEGRITY TEST(0.1 GPH) (17. SELF MONITORING GRAVITY FLOW(Check NI that avvlYL ❑8. DAILY VISUAL MONITORING SECONDARILY CONTAINED PIPING 139 BIENNIAL INTEGRITY TEST(0.1 GPH) PRESSURIZED PIPING(Check all that apply): SECONDARILY CONTAINED PIPING 10. CONTINUOUS TURBINE SUMP SENSOR WITHAUDIBLE AND VISUAL PRESSURIZED PIPING(Chmk all that apply). ALARMS AND(Check one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ®a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ALARMS AND(Check otm) ®b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 11 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS DISCONNECTION ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYS"FAILURE AND SYSTEM ❑c. NO AUTO PUMP SHUT OFF DISCONNECTION ® 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT Oc NO AUTO PUMP SHUT OFF OFF OR RESTRICTION ❑11. AUTOMATIC LEAK DETECTOR ® 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM [112. ANNUAL INTEGRITY TEST(0.I GPH) SUCTION/GRAVITY SYSTEM ❑13. CONTINUOUS$UMPSENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all mat apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• EMERGENCY GENERATORS ONLY(Check all that apply) AUDIBLE AND VISUAL ALARMS ❑14. CONTINUOUS SUMP SENSOR WITS ACRO PUMP SHUT OFF [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW AUDIBLE AND VISUAL ALARMS SHUT OFF OR RESTRICTION 1115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17. DAILY VISUAL CHECK [116.ANNUAL INTEGRITY TEST(0.1 GPH) ❑17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 1-1 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INSTALLED 468 ®2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑4.DAILY VISUAL CHECK 9/28/90 ®3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUTOFF FOR 5'TRENCH LINER/MONITORING DISPENSER+AUDIBLE AND VISUAL ALARMS [16.NONE IX.OWNER/OPERATOR SIGNATURE 469 I certify that the inf rmai ion provided herein is We am acwrate to the best of my knowledge SIGNATURE OF ON N R/ TOR ID.R,L2R,/ DA E NAME OF OWNER/OP TORS/N/02 470 (print) TITLE OFOWNER/OPERATOR Chevron Products Com any/D.R. LERI Retail ESH S ecialist °T' Perms Number(For bcel oseonly) ql Permit Approved(For real use only) Permit Expiratbn Dem(For bul use only) 473 11 PC F(f/99 revised)