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,EEB-07-2001 WED 03:45 PM QU 1 K STOP MU'S 1 NC MX NU, 51 Ulbb 11544 UNIFIED PROGRAM CONSOLIDATED FOR MW TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 Pa e VI.PIPING CONSTRUCTION(CN.a alt mat apply) L ONDERGROUNC)PIPING ABOVEGROUND PIPING 2. SUCTION C�3.GRAVITY a:a SYSt EM TYPE ®t.PIiLSSURE ❑2.SUCTION ❑3.GRAVITY 460 Q 1.PI(CSSURE Q 9G.UNKNOWN ao2, CONSIHUCf10Nl'^QI.SINIitEWALI 3•LINEDTRENCH 99.OTHER 4ti0 1.SINGL( WALL OTHER MANUI'ACTURER 13 2.DOIJOI E WAIL ❑95.UNKNOWN [012.DOUBLE WALL p 461 MANUFACTURER,_ ��3 �- MANUFACTURERAQSmith_ 1 UARE STEEL ❑6•FRP COMPATIBLE wn00%W71 ONO LJ t,3AitE v i CF.'_ {9 0• F,COMPATIBLE wh00X Mt fHANOL ❑2 STAINLESS STEEL 0 7.GALVANIZED STEEL ❑i.STAiN(CSS STEEL. [3 7.CALVAN17FD STEEL ❑UKNOWN ❑ C1 3.PLAS'iC COMPATIOLE Wl CONTENTS Q 90. OTHCR C33. PLASTIC COMPATIBLE WI CONI ENT$ O 8•FLEXIBLE(HDPE) I3 99 CTi!=R r]4. FIBERGLASS ❑9.CATHODIC PROI'ECf ION ❑1 F!;iF.RCLASS Q B.FLEXIBLE(HOPE) 95.UNKNOWN ' ❑5 STEE'_WCOATING ❑9 CATHODIC PROTECTION 4an ❑S• STEEL WICOATING C) VII.PIPING LEAK DETECTION(014ck A tnnt a v1(A At�cil uon of U u monirorinp program stv�A�e VEGROUNDb-flad 10 �PIPING lomil agency.) UNDI'.RGROUNO PIPING 466 SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(check all It+Mt apply)' PRf`_SSURI2C4 PIPING(Cl4d MI Ndifflr) AUTO []I. ELECTRONIC LINE LEAK DETECTOR 3 0 GrN TEST WJ(JI AUTO PUMP SHUT OFF POR ❑i LEAK.SYSTEM FAILURE•,ANNIC UNE LEAK DIE1 ECTOR 3.0 GPM TEST D SYSTEM DISCONNECTION,AUDIBLE ANO V$LCLf FOri LEAK,SYSTEM FAILURE,AND SYSIEM DISCONNECTION,AUDIBLE AND VISUAL ALARMS ALARMS. 02. MONTHLY 0.2 GPM TEST i [32. MONTHLY 0.2 GPH TEST [33, ANNUM.INTEGRITY TEST(O.iGPH) Q l ANNUAL INTEGRITY T EST(0.101"1 [14, DAILY VISUAL CI ICCK CONVEIvT10NA1.SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Cts all that tvdr) 1 S. M LY VISUAL MONITORING OF PUMPING SYSTEM*TRIENNIAL PIPING INfCGRITY [15, DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(01,GPH) ❑G, TRICNNIAL INTEGRITY TEST(0.1 GPM SA'T.SUC,10"1 SYSTE MS'(NO VALULS IN BELOW GROUNDPIPING): $AFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' t]7. SL,.F MONITORING []7. SELF MONITORING GRAVITY FLOW GRAVI TY FLOW lCtau all 010OPPO [] 0 C NMA,INI LGRITY TEST(0.1 GPI h [311. DNLY VISUAL MONROWNG Q 9. BIENNIAL INTEGRITY TEST(0.1 GPM SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSUK17F_D PIPING(Cnrck ill Uiat apply); PRESSURIZED PIPING(CuecK all that apply); 10. CONTINUOUS TURDINE SUMP SENSOR AUDIDLF•.AND VISUAL ALARMS AND 10. (�TIaNreOUS TURBINE SUMP SENSOR�AUDIBLE AND VISUAL Al ARMS ANO ,I (CIxta a:a) ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS t]n. AUrI 0 PUMP SHUT OFF WI-ICN A LEAK OCCURS i b AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE D SYS?EV ED, AUTO PUMP SI IUT OFF FOIL l EAKS,SYSTEM FAILURC ANO SYSICM Q AN DISCONNECTION DISCONNECTION Oc NO AUTO PUMP SHUT OFF ❑r NO AUTO PUMP SHUT OFF 11. AUTOMATIC UNE LEAK DLTFCTOR(3.0 GPM TES1) WITH FLOW SHUTor•F OR Q 11 AUTOMATIC LEAK DETEC TOR RCSTRICIION ❑12. ANNUAL INTEGRITY TEST(0.1 GPM) �`U� ❑12 ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONIGRAVITY SYSI EM SUCT'AtWGIV V TY SYS'f FM ❑13. C�'N7:N000S SUMP SENSOR*AUOIULF AND VISUAL ALARMS Q 13 CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chock oll Ust apply) EMERGENCY GENERATORS ONLY(Cheek en tnat a�ldr) (M CONTINUOUS SUMP SCNSORWIT AUTO PUMP SHUT OFF+AJ&ELE AND 014 CONI INUOUSSUMPSEN3011bITHOUTAUTO PUMP 51IUTOFF+AUOIrII.EAND 1]14. 1ASUALALARMS VISUALAIARMS C1 15, AUTOMATIC LINE LEAK DETECTOR(3.0 CPH TEST)1L__QU.T FLOW SHUT OFF OR [115. AUTOMATIC LINE LEAK DETECTOR(J 0 GPM TEST) RESIRICTION Q 16. ANNUAL INTEGRITY TEST(0.1 GPH) [�1S. ANNUAL.LNTF.CRITY IEST(0.1 GNI) [:117. DNLY VISUAL CHECK [3,,/. CAI Y VI;UAL CI ICCK DISPENSER CONTAINMENT -� 4,GAILY VISUld CHECK DISPtNSERCON'fAINML'NT L�1• rLOATMECFIANISMTIWTSHUTSOFFSIfLARVALVE S.TRENGILINERIMONIIORING 0n1'E INSTAL 1 CO 4G® (32. CONTINUOUS DISPENSER PAN SENSOR*AUDIBLE AND VISUAL ALARMS © 4 e 33. CONTINUOUS DISPENSER PAN SCNSOR Wlrtt AUTO SHUT OFF FOR DISPCNSER• Q 6.NONC AUDIBLE AND VISUALALARw M ._--_ .......--- IX.OWNER/OPERATOR SIGNATURE i u+airy tnal u:p In1UrmDuan pravl0el hrr4in Is I(u0 and eccurolo to 1111Clost of my kr:owlu07^• �„ SIGNUR ATE OF NE P TOR DATE TITLE OF OWNER/OPERATOR 172 NAME Or OWNC R/01rRATOR(Print) ar Director Of Environmental Affairs Mike Karvelot,for Quik Slop Markets, Inc. Pcrmlt Explraflon Date(For load jee only) p,11 flit Numucr(ro(local uno only) 473 PeriNl Apnrov::J(For local V!,&only) 475 Formerly SWRCB Form B IJPCF (1199 revised) 0 0 iia 41 ---