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NIFIED PROGRAM CONSOLIDATED FOR! TANK: PRO231173 ` 1. p PR H: FA0006423 W ,F1Z/J�, FAC H: FA0006423 UNDERGROUND STORAGE TANKS - K PAGE VI.PIPING CONSTRUCTION(Cleek01 that appy) e.ae s on UNDERGROUND PIPDJG ABOVEGROUND P�MG 459 SYSTEM TYPE ® I.PRESSURE El1.2.SUCTION ❑ 3.GRAVITY 458 ❑ PRESSURE E]2.SUCTION El 3.GRAVITY CDNSTRtICT1DN F-11.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER a60 ❑ 2.SINGLE WALL L ❑95.UNKNOWN AL 0 62 DOUBL J ®2.DOUBLE WALL 95.UNKNOWN 461 ❑ 463 MANUFACTURER f/� MANUFACTURER ❑ 1.BARE STEEL ❑6.FRP COMPATIBLE w loo%METHANOL ❑ 1,BARE STEEL ❑6.FRP COMPATIBLE as 100%METHANOL ❑ 2 STAINLESS STEEL [17.GALVANIZED STEEL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL 95 UNKNOWN E]PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN r-1 PLASTIC COMPATIBLE W/CONTENTS ❑ q,FlBERGIASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER 4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER db1 ❑ S.STEEL W/COATING ❑9.CATHODIC PROTECTION 465 5.STEEL W/COATING ❑9.CATHODIC PROTECTION W.PIPING LEAK DETECTION ICnk dl"N apply) dcaiPtbn orNcnmiu^e8 pmgranalWl besubmiltedto Melacd UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PeING 467 PRESSURIZED PIPING(Check a0 that apply): PRESSURIZED PIPING(Check all that apply): ❑ 1.ELECTRONIC LME LEAK DETECTOR 3.0 GPH TEST WITH AU70 PUMP SHUT OFF ❑ 1.ELECTRONIC LEVE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK.SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAr,SYSTEM FAILURE,AND SYSTEM DISCONNECTION,AUDIBLE AND VISUAL ALARMS. ❑ 2.MONTHLY 0.2 GPH TEST ❑2.MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS(Check all that apply) CONVENTIONAL SUCTION SYSTEMS ❑ 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING INTEGRITY TEST(0.1 GPH) ❑6.TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑ 7.SELF MONITORING ❑ 7.SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check all that apply): ❑9.BIENNIAL INTEGRITY TEST(0.1)GPH ❑8.DAILY VISUAL MONITORING ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Ch koro) ALARMS AND(a. as) ❑ a.AUTO PUMP STM 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 'Ab.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 LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR ❑ 11,AUTOMATIC LEAK DETECTOR RESTRICTION F112.ANNUAL INTEGRITY TEST(0.1 GPH) E] 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ EMERGENCY GENERATORS ONLY(Chock dl Mat PPh) EMERGENCY GENERATORS ONLY PUMP S appy) 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF ❑ 14.CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUTOFF• ❑ AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS IC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW IS.AUTOMATICOR LEAK DETECTOR(3.0 GPH TEST)WITHOUTFLOW E] 15.AUTOMAT SHUT OFF OR RESTRICTION ❑ SHUTTOFF OR RESTRIRI CTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK VID.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ® 1,FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4.DAILY VISUAL CHECK DATE INSTALLED "a ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS DL OWNER/OPERATORSIGNATURE Imtify Na eivfwma[im pmvihd M1aanubuceMamasteroaabat o(mykawlWge 470 SIGNATURE OF OWNER/OPERATOR DATE NAME OF OWNERIOPERATOR(pent) 471 TITLE OF OWNER/OPERATOR d72 Pn it A,p� (Faalodac -*) 474 Pemt Eapi onWe(Fkia PwmPT0ali m[Y) 475 0mcody) an EE0001273 12/31/2008 12:00:OOAM PT0002012013 UPCF(12/99 revised)