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pr o OFIED PROGRAM CONSOLIOATEO FOR \/ T�NKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 • s > Vt PwNG:CONSTRUC7lON(Checkaltd>etepphJ _aNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE X 1. PRESSURE r 2. SUCTION r 3. GRAVITY r 1. PRESSURE r 2. SUCTION r 3. GRAVITY 459 r 1. SINGLE WALL r 3. LINED TRENCH r 99. OTHER r 1. SINGLE WALL r 95. UNKNOWN 462 CONSTRUCTION X 2. DOUBLE WALL r 95. UNKNOWN r 2. DOUBLE WALL r 99. OTHER MANUFACTURE 461 MANUFACTURER 463 R MANUFACTURER r 1.BARE STEEL I 6. FRP COMPATIBLE W/100%METHANOL r 1 BARE STEEL I 6. FRP COMPATIBLE W/100%METHANOL MATERIALS AND r 2. STAINLESS STEEL r 7. GALVANIZED STEEL 1' 2. STAINLESS STEEL r 7. GALVANIZED STEEL CORROSION r PROTECTION 3. PLASTIC COMPATIBLE WITH CONTENTS 1195. UNKNOWN r 3. PLASTIC COMPATIBLE WITH CONTENTS IF S. FLEXIBLE(HDPE) r 99. OTHER X 4. FIBERGLASS r S. FLEXIBLE(HDPE) r 99. OTHER r 4. FIBERGLASS r 9. CATHODIC PROTECTION r 5. STEEL W/COATING r 9. CATHODIC PROTECTION 464 IF 5. STEEL W/COATING I 95, UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all UWappy)(A descripdon offt nwitoring shalllie.submweatO `Iocatagency) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply). PRESSURIZED PIPING(Chock all that apply): r 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 FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ALARMS r 2. MONTHLY 0.2 GPH TEST I 2. MONTHLY 0.2 GPH TEST r 3. ANNUAL INTEGRITY TEST(0.1 GPH) r 3. ANNUAL INTEGRITY TEST114-6PH) r 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS(Check all that apply): CONVENTIONAL SUCTION SYSTEMS. F 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY r 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) r 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 r 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW(Check all that apply): 9 BIENNIAL INTEGRITY TEST(0.1 GPH) r 8. DAILY VISUAL MONITORING 1 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. 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 r b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM r b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION c. NO AUTO PUMP SHUT OFF r c. NO AUTO PUMP SHUT OFF 1 X 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) r 12. ANNUAL INTEGRITY TEST(O.t GPH) SUCTION/GRAVITY SYSTEM. SUCTION/GRAVITY SYSTEM: I 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS r 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 I 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) I' 16, ANNUAL INTEGRITY TEST(0.1 GPH) h 17. DAILY VISUAL CHECK r 17. DAILY VISUAL CHECK VIIL bISPENSER CONTAINMENT DISPENSER CONTAINMENT r 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE F 4, DAILY VISUAL CHECK DATE INSTALLED 468 r 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS r 5. TRENCH LINER I MONITORING )998 X 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS F 6, NONE 469 FRIOPFRA q'nNAn IRE I cantly that the information provided herein is true and accurate t be of my knowledge. SIG RE OF OWNE PERATOR DATE 470 415/02 E OF ONMER/OPERATOR(print) 471 TITLE OF OWNERIOPERATOR 472 6ruce T.Marubashi for Shell Oil Producst US H,S&E Analyst 925-766-3498 Permit Number(For local use only) 473 1 Permit Approved(For local use only) 474 Permit Expiration Date(For local use only) 475 6