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j -•- NIFIED PROGRAM CONSOLIDATED FORM �ANKS UNDERGROUND STORAGE TANKS'- TANK PAGE 2 ,° „,,VI.PIPING.CONSTRUCTION(Chwkellthatappty} " -DERGROUND PIPING VQ . /)IJCA4I8�RO;l 11lG,�E1 II,� J r� ABOVEGROUND PIPING iYSTEM TYPE F 1. PRESSURE I' 2. SUCTION r 3. GRAVITY r 1. PRESSURE r 2. SUCTION r 3. GRAVITY 459 ;ONSTRUCTION F 1. SINGLE WALL F 3. LINED TRENCH I 99. OTHER F 1. SINGLE WALL F95. UNKNOWN 462 F 2. DOUBLE WALL r 95. UNKNOWN r 2. DOUBLE WALL r 99. OTHER AANUFACTURE MANUFACTURER 461 MANUFACTURER 463 2 r 1.BARE STEEL I 6. FRP COMPATIBLE W/100%METHANOL I 1. BARE STEEL I 6. FRP COMPATIBLE W/100%METHANOL AATERIALS AND r 2. STAINLESS STEEL r 7. GALVANIZED STEEL r 2. STAINLESS STEEL r 7. GALVANIZED STEEL IROTEON C IO I 3. PLASTIC COMPATIBLE WITH CONTENTS I'95. UNKNOWN r 3. PLASTIC COMPATIBLE WITH CONTENTS r 8. FLEXIBLE(HDPE) r 99. OTHER 'ROTECTION r 4. FIBERGLASS r 8. FLEXIBLE(HDPE) r 99. OTHER r 4. FIBERGLASS I'9. CATHODIC PROTECTION I 5. STEEL W/COATING IF 9. CATHODIC PROTECTION 464 r 5. STEEL W/COATING r95. UNKNOWN 465 VII.PIPING LEAK DETECTION(Check alt that apply)(A description of the monitoring ptgprem 8h4ll be,submltted tP the local agency) UNDERGROUND PIPING ABOVEGROUND PIPING TINGLE WALL PIPING 466 SINGLE WALL PIPING 467 'RESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check ell that apply): 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 F 2. MONTHLY 0.2 GPH TEST 2. MONTHLY 0.2 GPH TEST F 3. ANNUAL INTEGRITY TEST(0.1 GPH) 3. ANNUAL INTEGRITY TEST(0.1-GPR" 4. DAILY VISUAL CHECK :ONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that apply): 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY I 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) I 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) iAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 7. SELF MONITORING r 7. SELF MONITORING WITY FLOW: GRAVITY FLOW(Check all that apply): BIENNIAL INTEGRITY TEST(0.1 GPH) r 8. DAILY VISUAL MONITORING I 9. BIENNIAL INTEGRITY TEST(0.1 GPH) iECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING 'RESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10 US TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND Check one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) 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 I b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION r c. NO AUTO PUMP SHUT OFF r c. NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR r 11. AUTOMATIC LEAK DETECTOR' RESTRICTION 12. ANNUAL INTEGRITY TEST(0.1 GPH) I 12. ANNUAL INTEGRITY TEST(0.1 GPH) ;UCTION/GRAVITY SYSTEM: SUCTIONIGRAVITY SYSTEM: 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS I 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check ell that apply) EMERGENCY GENERATORS ONLY(Check all that apply) 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND I 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUAL ALARMS ALARMS 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR I 15, AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION 16. ANNUAL INTEGRITY TEST(0.1 GPH) I 16. ANNUAL INTEGRITY TEST(0.1 GPH) 17. DAILY VISUAL CHECK I1 17. DAILY VISUAL CHECK VIII.DISPENSER.C.ONTAINMENT ASPENSER CONTAINMENT h 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 14. DAILY VISUAL CHECK DATE INSTALLED 468 r 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS r 5. TRENCH LINER/MONITORING r 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS r 6. NONE 469 I certify that the information provided herein is true and accurate to the best of my knowledge. c GNAT E OF O ER/OPERATOR DATE 470 4/5/02 wat F OWNER/OPERATOR(pant) 471 TITLE OF OWNER/OPERATOR 472 Bruce T. Marubashi for Shell Oil Products US H,S&E 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 IPCF(1/99 revised) 7 Formerly SWRCB Form B