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MRIed Program onso 1 a e or TANKS UNDERGROUND STORAGE TANKS -TANKS PAGE 2 Page_of_ VI. PIPING CONSTRU TION (Check all tat app y UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE []2.SUCTION [:]3.GRAVITY 456 E]1.PRESSURE E]2.SUCTION [:]3.GRAVITY 459 []1 SINGLE WALL ❑3.LINED TRENCH [:]99.OTHER 460 L]1 SINGLE WALL [:]95.UNKNOWN 462 CONSTRUCTION/ 1:32.DOUBLE WALL C]95.UNKNOWN 112.DOUBLE WALL [-]99.OTHER MANUFACTURER MANUFACTURER 461 MANUFACTURER 463 1 SINGLE WALL �6.FRP COMPATIBLE W/100%METHANOL 1.BARE STEEL 06.FRP COMPATIBLE W/100%METNANOL MATERIALS AND X®2.DOUBLE WALL �7.GALVANIZED STEEL g2.STAINLESS STEEL �7.GALVANIZED STEEL CORROSION M3.PLASTIC COMPATIBLE WITH CONTENTS [:]95.UNKNOWN E]3.PLASTIC COMPATIBLE WITH CONTENTS E36.FLEXIBLE(HDPE) PROTECTION 1:1 4.FIBERGLASS [:]B.FLEXIBLE(HDPE) [:]99.OTHER 04.FIBERGLASS E]9.CATHODIC PROTECTION [-]5.STEEL W/COATING❑9.CATHODIC PROTECTION 464 E:]5.STEEL W/COATING 095.UNKNOWN 465 VII.PIPING LEAK DETECTION UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): E]1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO SHUT OFF FOR ❑I.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. 1:32.,NUN I HLY 02 UPH I GS I ❑2.MONTHLY 0.2 HPG TEST [:]3.ANNUAL INTEGRITY TEST(0.1 GPM) r-13.ANNUAL INTEGRITY TEST(0.1 GPM) [:14.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: rJ5.DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY CONVENTIONAL SUCTION SYSTEMS(Check all that apply): I i I(U.1 GPM) OS.DAILY VISUAL MUNI I URINE OF PIPING AND PUMPING SYS I EM SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): [:]7.SELF MONITORING F-16.TRIENNIAL INTEGRITY TEST(0.1 GPM) GRAVITY FLOW: SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): �9.BIENNIAL INTEGRITY TEST(0.1 GPM) ❑7.SELF MONITORING GRAVITY FLOW(Check all that appy): M8.DAILY VISUAL MONITORING M9.BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZE PIPING(Check all that Supply): PRESSURIZED PIPING(Check all that apply) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check ®1U.GUN I INUUUS I UKBING SUMP Si WI I H AUUIBLL AND VISUAL ALAKMS AND one) (Check one) [-]a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS X-a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS. [:]bAUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION Fjb.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c.NO AUTO PUMP SHUT OFF WHEN A LEAK OCCURS. ❑t.NO AUTO PUMP SHUT OFF F-11 I.AUTOMATIC LEAK DETECTOR �11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION. 12.ANNUAL INTEGRITY TEST(0.1 GPM) r-I12.ANNUAL INTEGRITY TEST(0.1 GPM) SLMON/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 all Nat appy) EMERGENCY GENERATORS ONLY(Check BY that apply) rl14.CUN I INUUUS SUMP SGNSUR WI I HUU I F LUW SHU I iUK �14.GUN I INUUUS SUMP SENSOR W I I HUU I AU I U PUMP SHU I UFF-AUUIBLL AMU VISUAL VISUAL ALARMS ALARMS �Ib.AU I UMA I IU LING LEAK UE I LU I UH(U.0 GPH I LJ I)W I I HUU I FLUW SHU I UFF UK 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) �16.ANNUAL INTEGRITY TEST(0.1 GPM) 16.ANNUAL INTEGRITY TEST(0.1 GPM) 11.DAILY VISUAL CHECK 1/.DAILY VISUAL UHLGK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 4.DAILY VISUAL CHECK DATE INSTALLED 46B O2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 05.TRENCH LINERIMONITORING D 1,GUN III UISPENSEK PAN SGNSUR WI I K AU IU SHU I UFF -UK UISPENSEK-AUUIBLE AND VISUAL ALARMS 6,NONE 469 XL OWNER/OPERATORISIGNATURE �P I certify that the information provided herein Is true and accurate to the best of my knowledge. SIGNATURE OF OWNERIOPERATOR DATE 470 NAME OF OWNER/OPERATOR(print) 411 TITLE OF OWNER/OPERATOR 472 Kenneth M.Phillips Manager,Loss Control,Repairs and Maintenance Perni Nuddeer(For local use only) 473 Pei Approve (Forloctil use only) 474 Parent Expiration Date(Forlocal use onyJ 475 UPCF(199) Formerly S W RCB Form B