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' IIFIED PROGRAM CONSOLIDATED FOR TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all that apply) plicable, no remote fi/1 ABOVEGROUND PIPING SYSTEM TYPE r 1. PRESSURE r 2. SUCTION r 3. GRAVITY r 1. PRESSURE F 2. SUCTION F 3. GRAVITY 459 CONSTRUCTION I 1. SINGLE WALL F 3. LINED TRENCH 199. OTHER r 1. SINGLE WALL r 95. UNKNOWN 462 / F2. DOUBLE WALL r 95. UNKNOWN r 2. DOUBLE WALL 199. OTHER MANUFACTURE R MANUFACTURER 461 MANUFACTURER 463 r 1.BARE STEEL r 6. FRP COMPATIBLE W/100%METHANOL r 1. BARE STEEL 16. FRP COMPATIBLE W/100%METHANOL MATERIALS AND r 2. STAINLESS STEEL r 7. GALVANIZED STEEL r 2. STAINLESS STEEL r 7. GALVANIZED STEEL CORROSION I PROTECTION 3. PLASTIC COMPATIBLE WITH CONTENTS I 95. UNKNOWN I 3. PLASTIC COMPATIBLE WITH CONTENTS I B. FLEXIBLE(HDPE) r 99. OTHER F 4. FIBERGLASS r B. FLEXIBLE(HDPE) r 99. OTHER r 4. FIBERGLASS r 9. CATHODIC PROTECTION F 5. STEEL W/COATING r 9. CATHODIC PROTECTION 464 I 5. STEEL W/COATING 195. UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that apply)(A description of the monitoring program she#be submitted to the local 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): I 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR r 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM'PAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL 'SYSTEM.FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ALARMS IF 2. MONTHLY 0.2 GPH TEST r 2. MONTHLY 0.2 GPH TEST r 3. ANNUAL INTEGRITY TEST(0.1 GPH) I 3. ANNUAL INTEGRITY TEST(0.1 GPH) F 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that apply): r 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY r 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) I 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): r 7. SELF MONITORING F 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW(Check all that apply): I 9. BIENNIAL INTEGRITY TEST(0.1 GPH) I 8. DAILY VISUAL MONITORING I 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 CONTINUO(Check one)US TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) I a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS r a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS I b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM I b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION F c. NO AUTO PUMP SHUT OFF I c. NO AUTO PUMP SHUT OFF r 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR r 11. AUTOMATIC LEAK DETECTOR RESTRICTION I 12. ANNUAL INTEGRITY TEST(0.1 GPH) I 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: I 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS I 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) I 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 r 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION I 16. ANNUAL INTEGRITY TEST(0.1 GPH) I 16. ANNUAL INTEGRITY TEST(0.1 GPH) I 17. DAILY VISUAL CHECK I 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT r 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE r 4. DAILY VISUAL CHECK DATE INSTALLED 468 F 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS r 5. TRENCH LINER/MONITORING I 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS 16. NONE 469 1 certify that the information provided herein is true and accurate to the best of my knowledge. S NAT F 0!!�TOR DATE 470 12/6/01 NAME OF OWNER/OPERATOR(print) 471 TITLE OF OWNER/OPERATOR 472 Bruce T. Marub shi for E uilon Enterprises LLC PERMIT ANALYST 925 766-3498 Permit Number(For local use only) 473 I Permit Approved(For local use only) 474 I Permit Expiration Date(For local use only) 475 ' UPCF(1/99 revised) 7 Formerly SWRCB Form B