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�IIIEO PR OO RAM 7017310 TED FOR � UNDERGRO LAND STORAGE TANKS - TANK P AGE 2 TANKS UNDERGROUND PIPING VI:PIPING CONSTRUCTION SYSTEM TYPE ICMck a/Mal appy) Z d I❑❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3 GRAVITY /.Jp 1. SINGLE WALL ABOVEGROUND PIPING MANUFACTURER ❑ J. UNEP TRENCH ❑ 1' PRESSURE MANUFACTURER❑ 2, DOUBLE WALL ❑99 OTHER 430 ❑ 1. SINGLE WALL ❑ 2' SUCTION ❑93. UNKNOWN ❑ J. GRAVITY /59 MANUFACTURER ❑2. DOUBLE WALL ❑95. UNKNOWN �.BARE STEEL ❑ S. FRP COMPATIBLE W/100%M 431 ❑99. OTHER 462 MATERIALSAND ❑ 2, STAINLESS MANUFACTURER CORROSION STEEL ❑ 7. GALVANIZED STEEL ETHANOL 91, BARE STEEL PROTECTION ❑ J. PLASTIC COMPAT ❑ S. FRP COMPATIBLE W/10016 METHANOL 4113 BLE WmL CONTENTS ❑2. STAINLESS STEEL ❑ 4. FIBERGLASS ❑ B. FLEXIBLE Hp ❑9S UNKNOWN ❑ 3. PLASTIC COMPA L WITH CO ❑ 7' GALVANIZED STEEL ❑ 5. STEEL W/COATING ❑ 9. ( PEI ❑99. OTHER ❑4, FIBERGLASS CONTENTS ❑ 9. FLEXIBLE(HOPE) CATHODIC PROTECTION ❑99. OTHER 4Bt ❑ 5. STEEL W/COATING ❑ 9• CATHODIC PROTECTION UNDERGROUND PIPINGVII.PIPING LEAK DETECTIONChatAa►ti ❑9s. UNKNOWN l ,) PRESSURIZED PIPING(Chad of 9W SINGLE WALL PIPING '. ,. 465 ❑ 1. ELECTRONIC UNE L appy), 495 ABOVEGROUND PIPING LEAK DETECTOR J.0 GPH TEST W�7H A PRESSURIZED PIPING(Checked Mel SINGLE WALL PIPING LEAK SYSTEM FAILURE,AND SYSTEM p UTO PUMP SHUT OFF FOR APa'Y1 M7 ALARMS L9COM'IECTION*AUDIBLE AND VISUAL ❑ 1. ELECTRONIC UNE ❑ 2 MONTHLY 02 GPH TEST SYSTEM FAILU LAND SYSTEMEAK DETECTOR].0 GPH TESTAID PUMP SHUT OFF FOR LEAK, ❑ J. ANNUAL INTEGRITY ❑ 2. MONTHLY 02 GPH TEST DISCONNECTION-q DIBLE AND VISUAL ALARMS TEST(0.1 GPHI ❑ J. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS; ❑ 4. DAILY VISUAL CHECK ❑ I. DAILY VISUAL MONITORING OF PUMPING$Y$TEAI TRIENNIAL PIPING I CONVENTIONAL SUCTION SYSTEMS(Chea aapNf TEST(0.1 GPH) NTEGRITY S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTE SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ S. TRIENNIAL INTEGR17Y TEST Al GPH) M ❑ 7SELF MONMORWG SAFE SUCTION SYSTEMS(No VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑ 7. SELF MONITORING ❑ 9. BIENNIAL INTEGRrTy TEST(0.1 GPH) GRAVITY FLOW(Check a a 0yf appy).' ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0-1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING((7Mny ad Sul APP'Y): SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Ged ae 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND Ihat appy). (CheckPne) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL A ❑ a. AUTO PUMP SNOT OFF WHEN A LEAK OCCURS ane) LARMS AND(check, ❑ b. AUTO RUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS DISCONNECTION ❑ c NO AUTO RUMP SHUT OFF ❑ b. AUTO RUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ 11. AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)WrrH FLOW SHUT OFF OR ❑ NO AUTO PUMP SHUT OFF RESTRICTION 13 11. AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) ;UCTION/GRAVITY SYSTEM: ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) ] 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS SUCTION/GRAVITY SYSTEM: EMERGENCY GENERATORS ONLY(Check al hm ppI ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND ASUAL ALARMS ] 14. CONTINUOUS SUMP SENSOR WRMOU AUTO PUMP SHUT OFF.AUDIBLE AND EMERGENCY GENERATORS ONLY(Check ap Melappy) VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHO AUTO PUMP SHUT OFF-AUDIBLE AND VIS 15. AUTOMATIC UA NE LEAK DETECTOR(3.0 GPH TEST)W rHO FLOW SHUT OFF OR RMS UAL RESTRICTION ❑ I5. AUTOMATIC LINE LEAK DETECTOR(3.0 GRI TEST) 7 16. ANNUAL INTEGRITY TEST(0.1 GPH) 117. DAILY VISUAL CHECK ❑ 13. ANNUAL INTEGRITY TEST Al GPH) ❑ 17. DAILY VISUAL CHECK r. VIII.DISPENSER CONTAINMENT AENSER CONTAINMENT ❑ 1 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ATE INSTALLED tSB ❑ 2. CONTINUOUS DISPENSER PAN SENSOR AUDIBLE AND VISUAL ALARMS C3 4. DAILY VISUAL CHECK ❑ ,. S. TRENCH LINER/MONITORING ElWITHJ. CONTINUOUS DISPENSER PAN SENSOR WAUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS l/7 B, NONE 'IX OWNERIOPERATOR SIGNATURE 489 p h t • U MI PpMeew*n N abaaau W 11W beal of My knowledge. F RAT GATE y �� / 770 M Of OWNER/O TOR(p0 b471 TITLE O OWNERAOPERATOR 14 Int NumOer(fd IOCaI uaa ONS) 473 I PamM A00rOvaO IFd 4pa1 uaa Prey) 4]4 PMMA EapIP1lWn Dala(FOl,bta/yaa eryyl 475 .F(1199) • • Formerly SWRC8 Form B