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I UNIFIED PROGRAM CONSOLIDATED FORM 0 C 1 0 3 20U2 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 I VI.PIPING CONSTRUCTION(Check all Mat apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE X 1 PRESSURE F 2 SUCTION F 3. GRAVITY F 1. PRESSURE r 2. SUCTION F 3 GRAVITY 459 CONSTRUCTION F 1 SINGLE WALL F 3 LINED TRENCH F 99. OTHER F 1. SINGLE WALL F95 UNKNOWN 462 t X 2. DOUBLE WALL F 95 UNKNOWN r 2. DOUBLE WALL r 99. OTHER MANUFACTURE R MANUFACTURER 461 MANUFACTURER 463 r 1 BARE STEEL F 6. FRP COMPATIBLE Wl 100%METHANOL F 1. BARE STEEL F 6 FRP COMPATIBLE W/100%METHANOL MATERIALS AND F 2. STAINLESS STEEL F 7 GALVANIZED STEEL F 2. STAINLESS STEEL F 7 GALVANIZED STEEL CORROSION PROTECTION r 3 PLASTIC COMPATIBLE WITH CONTENTS F 95 UNKNOWN r 3. PLASTIC COMPATIBLE WITH CONTENTS F 8. FLEXIBLE(HDPE) F 99 OTHER X 4 FIBERGLASS F 8 FLEXIBLE(HDPE) F 99 OTHER r 4 FIBERGLASS F 9 CATHODIC PROTECTION F 5. STEEL W/COATING F 9 CATHODIC PROTECTION 464 F 5. STEEL W/COATING r 95. UNKNOWN 465 VII.PIPING LEAK DETECTION(Check aft that apply)(A descrip Uion of Me monitodrig program shay be submtthtd to the tical agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply) - F 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR F 1 ELECTRONIC LINE LEAK DETECTOR 3 0 GPH 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 F 2. MONTHLY 0.2 GPH TEST F 2 MONTHLY 0 2 GPH TEST F 3. ANNUAL INTEGRITY TEST(0 1 GPH) F 3 ANNUAL INTEGRITY TEST(0.1 GPH) F 4 DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS. CONVENTIONAL SUCTION SYSTEMS(Check ad that apply). I 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY r 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) F 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) F 7 SELF MONITORING F 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check as that apply): F 9 BIENNIAL INTEGRITY TEST(0 1 GPH) r 8 DAILY VISUAL MONITORING F 9 BIENNIAL INTEGRITY TEST(O 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 ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) (Check one) - X a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS r a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS F b AUTO PUMP SHUT OFF FOR LEAKS SYSTEM FAILURE AND SYSTEM F b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION F c NO AUTO PUMP SHUT OFF F c NO AUTO PUMP SHUT OFF X 11 AUTOMATIC LINE LEAK DETECTOR(3 0 GPH TEST)WITH FLOW SHUT OFF OR r 11 AUTOMATIC LEAK DETECTOR RESTRICTION X 12 ANNUAL INTEGRITY TEST(0.1 GPH) r 12 ANNUAL INTEGRITY TEST(0 1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM 13 CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS F 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) F 14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND r 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUAL ALARMS ALARMS F 15 AUTOMATIC LINE LEAK DETECTOR(3 0 GPH TEST)WITHOUT FLOW SHUT OFF OR F 15 AUTOMATIC LINE LEAK DETECTOR(3 0 GPH TEST) RESTRICTION I 16 ANNUAL INTEGRITY TEST(0 1 GPH) F 16 ANNUAL INTEGRITY TEST(0 1 GPH) F 17 DAILY VISUAL CHECK r 17. DAILY VISUAL CHECK Vlll.DISPENSER CONTAINMENT DISPENSER CONTAINMENT X 1 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE r 4 DAILY VISUAL CHECK DATE INSTALLED 468 r2 CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS r 5 TRENCH LINER/MONITORING 1990 F3 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS F 6 NONE 469 IX OWNFR/IIP RATQR SIFSNATI IRF I I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNAT E OF OWNER/pPERATOR DATE 470 9124/02 NAME OF OWNER/OPERATOR(print) 471 TITLE OF OWNERIOPERATOR 472 Bruce T. Marubashi for Shell Oil Products US HSE Analyst 925-766-3498 Permit Number(For local use only)Number(For local use only) 4731Penmt Approved(For local use only) 474 I Permit Expiration Date(For local use onlyl 475Approved(For local use only) 474 I Penmit Expiration Date(For local use onlyl 475 6