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PIED PROGRAM CONSOLIDATED Foe TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(flack ad that apply) UNDERGROUND PIPING ABOVEGROUND PIPING BYSTEM TYPE ❑ 1 PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ L PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ 1.SINGLE WALL ❑ 3. UNEO TRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER 1.BARE STEEL ❑ S. FRP COMPATIBLE Val IW%METHANOL ❑ 1. BARE STEEL ❑ e. FRPCOMPATIBLEWIIW%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ Z. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE KITH CONTENTS 095. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 11 B. FLE%IBLE(HOPE) 099. OTHER ❑ 4. FIBERGLASS ❑ a. FLEXISLE(HOPE) 099. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL VVI COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑95. UNKNOWN VII,PIPING LEAK DETECTION(Check M that apply) UNDERGROUND PIPING ABOVEGROUNO PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chock ad that apphq: PRESSURIZED PIPING(Check ad that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WTH AUTO PUMP SHUT OFF FOR LEAK- LEAK, EAKLEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3. ANNUAL UAL CHECKRITY (0.1 GPM) ❑ 4. GAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check aN that apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ S. TRIENNIAL INTEGRITY TEST IDA GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW. GRAVITY FLOW(Check aY that apply): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ 8. WILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(O.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that appy): PRESSURIZED PIPING(Check ad that appy). 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Chdr .he) 10.fANNNUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(tlleck 004f) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b_AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF ❑ c NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 1Z ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONIGRAVITY SYSTEM: SUCTIONIGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chock 0 that appy) EMERGENCY GENERATORS ONLY(Check ad that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TESD WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 16. ANNWLINTEGRITYTEST(0AGP11) ❑ 17. WILYVISWLCHECK ❑ 17. WILYVISWLCHECK VIII:DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. WILY VISUAL CHECK WTE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR t AUDIBLE AND ASUALALARMS ❑ 5. TRENCH UNERI MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑ 8. NONE IX.OWNERIOPERATOR SIGNATURE I Gamy that the infotmaboh Provided herein Ia We aha acwrale to as beat of my NIOW049e. SIGNATURE OF OWMER/OPERATOR DATE NAME OF OWNERK)PERATOR(phhf) TITLE OF OVMERIOPERATOR ParmR Number(FOtlocatuae ohly) Parma Apgpvee(fWIocalaae.W Pemla Eapeacon Data fFcY local use Oayy CUPAFORM(4/99) 0 Formedy SWRCB Form 8