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• ~01/03/2003 10:23 2095776PA 0 BOYETT PETROLEUM PAGE 02 Y 1 UACT-. t'�-f - MINIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION Cheel 111 mac paw_x UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE X 1,PRESSURE (12.SUCTION ❑3.GRAVITY 459 ❑1.PRESSURE 112 SUCTION El 3.GRAVITY 45P CONSTRUCMON ❑I.SINGLE WALL ❑3.LINED TRENCH 0 99.OTHER 46D ❑1,SINGLE WALL O 95,UNKNOWN 461. MANUFAcTuRERA2.DOUBLE WAL 45.UNKNOWN ❑2.OOLIFLP WALL ❑99.OTHGR MANUFACTURER 461 MANUFACTURER 463 [11.BARE STEEL ❑6.FRP COMPATIBLE w/tort% mETHANOL ❑1 GARP-,=- L ❑h-FRP COMPATIBLE W/IDD%MBTRANDL ❑2.STAINLESS STEEL [3 7.OALVAN17ED STEEL ❑Unk- ❑2. STAINLESS STEEL ❑7.GAI,VANr.7-ED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS [j99, Otho E33. PLASTIC COMPATIBLE W/CONTENTS ❑B.FLMBLE(KOFF) 13 >< 99. OTHE1,FTRF.RGT.ASS ❑S.FLEXIBLE(HDPE) ❑4. F113ERGLASS ❑9.CATHODIC PROTECTION X❑5.STEEL W/COATING ❑9,CATHODIC PROTECTION uA []5. STEEL W/COATI NG ❑ 'Y� 461 VTI.PTPING LEAK DBTECI'ION CII-k 1f1 Thar 1 n dewri tier+of the oioohorinx pTaIM.hall W.nMnWed m the foul c.. UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 4G7 PRESSUR1712D PIPING(Creak dl th.apply): PRESSURIZED PIPTNO(Check all tlmt npply), ❑ I.ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST.1�=AUTO PUMP SHUT ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WJ,Tti AUTO PUMP OFF FOR LEAK.SYSTEM FAILURE,AND SYSTEM DISCONNECTION 4' SMrr OFF FOR LEAK SYSTEM PATLURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ❑2.MONTHLY 0.2 OPH TEST ❑2, MONTHLY 0.2 OPH TEST ❑3.ANNUAL INTEGRITY TEST(0,1 GPIT) ❑3.ANNUAL INEGRTTY TP.CT(0.1 OPH) ❑4, DA 11 Y VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(cheek 111 that MP-*') ©5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING ❑5 DAILY VISUAL MONITORING OF PIPING AND T'UMPING SYSTEM INTEGRITY TEST(0.1 OPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING); Q 6. TRIENNIAL INTEGRITY TEST(O.1 GPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING); GRAVITY FLOW ❑7.SELF MONITORING O 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY PLOW(Cheek all that applyk ❑R. DAILY VISUAL MONTTORTNG I]9, BTENNIAL I ITEORITY TEST(0.1 GPI) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED TIEING PRP,SSVRI7,PD PIPING(Chock Iii u1r apply); PRESSUR171TI!PTPTNG(Cloak 111 that 1ppfy): 10. CONTINUOUS TURBINE SUMP SENSOR WM AUDIBLE AND VISUAL 10, CONTINUOUS TURBINE SUMP SENSOR=AUDIBLE AND VISUAL ALARMS AND(Chock one) ALARMS AND i cmo orc) [K.. AUTO PUMP SHUT Opp WHEN A LEAK OCCURS ❑n AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ©h. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑h AUTO PUMP si-ruT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNP.CTTON ❑c.NO AUTO PUMP SPIUT OFF ❑c NO AUTO PUMP SHUT OFF X-I I. AUTOMATIC LINE LEAK DETECTOR 0.0 GPH TEST)WM FLOW SHUT ❑11. AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION Wl12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12- ANNUAL INTEGRITY TEST(0,1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVM'SYSTEM ©13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Cheek an nut Apply) EMERGENCY GFNIKRATORS ONLY(/;beak all that"ply) ❑14. CONTINUOUS SUMP SENSOR WITHOIJf AUTO PUMP SHUT OFF• ❑14. CONTINUOUS SUMP SENSOR Mjfflta AUTO FUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIEI.E AND VISUAL ALARMS 15, AUTOMATIC LINE I,FAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT ORP OR RESTRICTION 16.ANNI•IAT,TNTPGRITY TP9'r(0.1 GPH) ❑16.ANNUAL INTP.GRTTY TEST(0.1 GPH) ❑17. DAILY VISUAL CHECK ❑17, DAILY VISUAL CHECK VITI.DISPENSER CONTAINMENT DISPENSER CONTAINMENT �1.FLOAT MECHANISM THAT SHUT OFF SHEAR VALVE ❑4.DATLY VISWJ.C14T3CK DATE INSTALLED 469 ❑2.CONTTNVOIJ$DISPQV9ER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑1,TRENCH I mum./MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6.NONE !! r DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNRR/OPFRATOR SIGNATURE I certify that tho Information tnmidod heroin a ttvo nod nccurntc to the yc�t M my krnt-kdr, SIONATU FR/OP R parr. 4M NnMP,OF WNER/OPR(pri ) 171 TITLE O O ER/OPERATOR 4"2 t Permit Nun*w(Por local um only) 473 F=O Apinvul(For local m6 only) 474 Pamtt Pdtpitltton!hue(Por mora UX poly) 475 UPCF(12/99 revised) 12 Founerly SWRCB Form B