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Kz V" to Aq-o2 AOL 03110-mied Program Consolidatea i-omV TANKS UNDERGROUND STORAGE TANKS -TANKS PAGE 2 Page_of V1. PIPING CONSTRU TION (Check all that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE [:]2.SUCTION [-]3.GRAVITY 456 El1.PRESSURE 02.SUCTION [:13.GRAVITY 459 [:]1 SINGLE WALL E]3,LINED TRENCH ❑99.OTHER 460 E]1 SINGLE WALL [:]95.UNKNOWN 462 CONSTRUCTION/ 02.DOUBLE WALL E]95.UNKNOWN C]2.DOUBLE WALL []99.OTHER MANUFACTURER MANUFACTURER 461 MANUFACTURER 463 MATERIALS AND X®2.SDOUBLE WALL LJ7.GAL AN ZEAD STEEL/100%METHANOL H2.STA STAINLESS STEEL ®7.GA.BARE STEEL LVANIIZED STEEL/100%METNANOL CORROSION r-13.PLASTIC COMPATIBLE WITH CONTENTS [:]95.UNKNOWN [-]3.PLASTIC COMPATIBLE WITH CONTENTS [:]B.FLEXIBLE(HOPE) PROTECTION ❑4 FIBERGLASS [:]8.FLEXIBLE(HDPE) E:]99.OTHER 04.FIBERGLASS [:]9.CATHODIC PROTECTION �5.STEEL W/COATING p9.CATHODIC PROTECTION 464 ']5 STEEL W/COATING E]95.UNKNOWN 465 VII. PIPING LEAK DETECTION I' UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): �1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO SHUT OFF FOR �1.ELECTRONIC LIEN LEAK DETECTOR 3.0 pH TEST WITH AUTO PUMP SHUT OFF FOR LEAK LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ALARMS. E]2.,MON I FLY 0.2 GPH I ES I ❑2.MONTHLY 0.2 HPG TEST E]3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) E]4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: F-15.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY CONVENTIONAL SUCTION SYSTEMS(Check all that appy): I ES 1(0.1 OPH) [:]b.DAILY VISUAL MUNI I UHING OF PIPING AND PUMPING SYS I EM SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): �7.SELF MONITORING 06.TRIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW: SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): D9.BIENNIAL INTEGRITY TEST(0.1 GPH) - [:]7.SELF MONITORING GRAVITY FLOW(Check all that appy): ❑e.DAILY VISUAL MONITORING I]9.BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZE PIPING(Clock all that Supply): PRESSURIZED PIPING(Check all that apply) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check ®1U.UUNIIN000S IUKBINESUMYSLNSUKWIIHAUUIbLEANUVISUALAL KMSANU ona) I]a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS (Check one) Ela.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS. E]b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION Me.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION 11c.NO AUTO PUMP SHUT OFF WHEN A LEAK OCCURS. I]c.NO AUTO PUMP SHUT OFF ❑11.AUTOMATIC LEAK DETECTOR �11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION. F-112.ANNUAL INTEGRITY TEST(0.1 GPH) 1112.ANNUAL INTEGRITY TEST(0.1 GPM) SU ON/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: �13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check ell Nat apply) EMERGENCY GENERATORS ONLY(Check all Nat apply) �14.GUN I INUUUS SUMP SENSUK WI I HUD I FLOW SHU I U"UK 14.WN I INUUUS SUMP SENSUK WI I HUU I AU I U HUMP SHU I U"f-AUDIBLE AND VISUAL VISUAL ALARMS ALAKM5 r-1ID.AU I UMA I IG LINE LEAK WE I tG I UK t3M UPH I LJ I)WI I HUU I FLUW SHU I UYY UK [:]15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) MI6.ANNUAL INTEGRITY TEST(0.1 GPH) F11(.DAILY VISUAL CHECK 1(.DAILY VISUAL CHECK Vlll.DISPENSER CONTAINMENT DISPENSER CONTAINMENT M1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04.DAILY VISUAL CHECK DATEINSTALLED 468 O2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [:]5.TRENCH LINERIMONITORING El J.UUN I INUUUS UISPENStK PAN SENSOR WI I H AU I U SHU I UFF FOR DISPENSER+AUUItlLt AND VISUAL ALARMS E:16NONE 469 XI: OWNERIOPERATOR SIGNATURE 1119 I cedi(y that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF OWNER/OPERATOR DATE 470 NAME OF OWNERIOPERKT R(print) 471 TITLEOFOWNER/OPERATOR 472 Kenneth M.Phillips Manager,Loss Control, Repairs and Maintenance ermit Number(For locall use only) 473 venhit Approved(For local use only) 474 PeFualiw Date(For local use only) 475 UPCF(199) Formed SWRCB Forrn B