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IIFIE0 PROGRAM CONSOLIDA750 F( I TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 i A.PIPING CONSTRUCTION(Check a/mat appy) UNCERGROUNO PIPING ABOVEGRCUNO�I PING SYS-=!d-,E ❑ , PRESSURE -❑1 ?. 3UCT1ON ❑ 3. GRAVITY C11 -RESSU'RE ❑ ' SUCTION 3. GRAVITY CONS-.RUCF.A�N SINGLE WALL ❑ 1. UNED TRENCH ❑99. OTHER SINGLE NALL 35 'JNKNOWN MANUFACTURERDOUBLE'NALL ❑95. UNKNOWN 2. DOUBLE'NALL 9 OTHER 1AC7URER `AANUFAC:JRER ❑ 1.BARE STEEL 1..._: o. =RP COMPATIBL'M 100%METHANOL ❑ 3ARE STEELI_: 3. DRP COMPATIBLZ-'M'00%METHANOL MA T ERIALS AND ❑ 2. STAINLESS STEEL ❑ 7 GALVANIZED STEEL ❑ 2- 57AINLSS STEEL ❑ - GALVANIZED STEEL CORROSION --I PRCTECTION ❑ 3. PLASTIC COMPATIBLE'MTH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WTH CONTENTS I_t 3. FLEXIBLE(HOPE) Cl 99. OTHER ❑ 4. FIBERGLASS ❑ 3. FLEXIBLE(HOPE) ❑99. DTHE.R ❑ 4. FIBERGLASS 3. DATHOOIC PRO,cC':CN ❑ i. STEEL'NI COATING 1:: 3. CATHODIC PROTECTION C i a.c3'NI COATING U 95. UNKNO`NN I VII.PIPING LEAK DETECTION(Check aA mar appy) JNDERGROUNO PIPING ABOVEGRCUNC PIPING SINGLE WALL PIPING S3NGLE WALL PIPING PRESSURIZED PIPING(Check all mat aopy): PRESSURIZED PIPING,Ch cm almor aoa": U t ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST`MTH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK OE.ECTOR 3.0 GPH,-S'.'MTH AUTO PUMP SHUT OFF FOR LEAK. LEAK.SYSTEM FAILURE..AND SYSTEM OISCONNECTION+AUOIBLE AND VISUAL SYSTEM FAILURE AND SYSTEM 0ISCONNEC710H-AUDIBLE AND VISUAL ALARMS ALARMS C3 MONTHLY 02 GPM TEST ❑ MONTHLY 0.2 GPM TEST I ❑ 1. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK I I CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS lChecat r as mapp": ❑ >. DAILY VISUALMONITORING OF°UMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ S. GAILY VISUAL MONITORING OF-PING AND PUMPNG SYS-cM TEST(0.1 GPM) ❑ 3. TRIENNIAL INTEGRITY TEST.0.1 GPM) II SAF_SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): I SAFE SUCTION SYSTEMS ANO VAt1✓ES IN BELOW GRCUNO PIRING3: ❑ SELF MONITORING ❑ r. SELF MONITORING I GRAVITY FLOW. GRAVITY FLOW(Check as mat Sop": 3. 31ENNIAL INTEGRITY 7ES7;0.1 GPM) j C!1 3. DAILY VISUAL!ACNITCRING ❑ 3. 31ENNLAL:•YTEGRITY TEST f0.1 GPM) I SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING 4heelc as that aooW: '0. CONTINUOUS TURBINE SUMP SENSOR'MTH AUDIBLE.ANO VISUAL ALARMS AND +0.CONTINUOUS TURBINE SUMP jEN$OR'MTH AUDIBLE AND VISUAL ALARMS AND(rtleCK One) 'Check onel ❑ a. AUTO PUMP SHUT CF='NHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT CFF'.%HEN A LEAK OCC'-RS ❑ o. AUTO PUMP SHUT CFF FOR LEAKS,SYSTEM FAILURE AND SYS--M p, .AUTO PUMP SHUT OF==OR LEAKS,SYST--A FAILURE AND SYSTBA CISCONNECTION DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF ❑ NO AUTO PUMP SHUT OFF j ❑ 1. AUTOMATIC LINE LEAK 0E i cCTOR(3.0 GPM TESTI WITH FLOW SMUT OFF OR ❑ tt. AUTOMATIC LEAK DETECTCR RESTRICTION ❑ 2. ANNUAL INTEGRITY 7ES7(0.1 GPH) ❑ '2 ANNl1AL:NTEGRITY cST;0.1 GPM) i SUCTIONVGRAVITY SYSTEM: SUC7TOWGRAVITY SYSTEM: ❑ '.3. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS j❑ '3. OONTINUOUS SUMP SENSOR-AUDIBLE AND`VISUAL ALARMS I I � EMERGENCY GENERATORS ONLY(Check all that app" EMERGENCY GENERATORS ONLY(Check ad that Sap" ❑ 14 CONTINUOUS SUMP SENSOR'MTI+OUT AUTO PUMP SHUT OFF-AUOIBLAND ❑ It CONTINUOUS SUMP SENSOR WTHOUT AUTO TJMP SHUT OFF-AUDIBLE AND VISUAL VISUAL ALARMS ALARMS C 'i5. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR C315. AUTOMATIC UNE LAK OE'cCTOR(3.0 GPM 7-=-T) RESTRICTION ❑ '8. ANNUAL INTEGRITY TEST r.0.'GPH) I❑ 18. ANNUAL INTEGRITY TEST(0.1 GPHI i.❑ '7 DAILY`VISUAL CHECK �❑ 17. GAILY VISUAL CHECK VIAL DISPENSER CONTAINMENT DISP9NSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DAILY VISUAL CHECK TATE INSTALLED ❑ Z CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS ❑ i --RENCH UNER V MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR`MTH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑ .3 NONE 0L OWNER/OPERATOR SIGNATURE cenrty mat the,ntomanon orovlaea hereln,s;r a ana acurate to me crest of my,n&A"0q&. SIGNATURE OF OWNER,OPERATCR 7AI. I I I i i .NAME OF OWNER/OPERATOR 1p-rl T ITLE OF CWNER)OPERATOR Demii Numoer iFor local use only) °-t(AODmvea IFor:ocat use only) - Demm Exogatlan Cate.F l ocat use Only) II I CUPAFORM(4/99) Formerly SWRCB Form 8