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IED PROGRAM CONSOLIDATED A& SITE#255886/5886 <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Check all that apply) Page of <br /> UNDERGROUNDPIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE ®1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 458 ❑1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 459 <br /> [11.SINGLE WALL [:13.LINED TRENCH ❑99.OTHER 460 ❑I.SINGLE WALL ❑95.XERXES 462 <br /> CONSTRUCTION/ ®2.DOUBLE WALL ❑95.XERXES ❑2.DOUBLE WALL ❑99.OTHER <br /> MANUFACTURER MANUFACTURER 461 MANUFACTURER 463 <br /> Ell.BARE STEEL E:16.FRP COMPATIBLE wt Ioo^r METHANOL ❑1.BARE STEEL El 6.FRP COMPATIBLE W/100%METHANOL <br /> MATERIALS AND ❑2.STAINLESS STEEL 07.GALVANIZED STEEL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL <br /> CORROSION ❑3.PLASTIC COMPATIBLE WITH CONTENTS [195.XERXES ❑3.PLASTIC COMPATIBLE WITH CONTENTS 08.FLEXIBLE(HDPE) ❑99.OTHER <br /> PROTECTION 04.FIBERGLASS ❑8.FLEXIBLE(HDPE) ❑99.OTHER ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION <br /> ❑5.STEEL W/COATING 09.CATHODIC PROTECTION 464 ❑5. STEEL W/COATING ❑95. XERXES 465 <br /> VII.PIPING LEAK DETECTION(Check all that apply)(A description of the monitoring program shall be submitted to the local agency.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, <br /> LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS <br /> ALARMS ❑ 2.MONTHLY 0.2 GPH TEST <br /> ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4.DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS(Check all that apply): <br /> CONVENTIONAL SUCTION SYSTEMS: <br /> El DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> ❑ 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING <br /> GRAVITY FLOW: GRAVITY FLOW(Check all that apply): <br /> ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) ❑ 8. DAILY VISUAL MONITORING <br /> ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING <br /> SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): <br /> PRESSURIZED PIPING(Check all that apply): <br /> 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) <br /> 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> (Check one) <br /> ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION <br /> ® b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM El c.NO AUTO PUMP SHUT OFF <br /> DISCONNECTION ❑ 11.AUTOMATIC LEAK DETECTOR <br /> ❑ c.NO AUTO PUMP SHUT OFF ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ® I1.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR <br /> SUCTION/GRAVITY SYSTEM: <br /> RESTRICTION <br /> ® 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> SUCTION/GRAVITY SYSTEM: EMERGENCY GENERATORS ONLY(Check all that apply) <br /> ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL <br /> ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND <br /> VISUAL ALARMS ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR ❑ 17.DAILY VISUAL CHECK <br /> RESTRICTION <br /> ❑ <br /> 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ 17.DAILY VISUAL CHECK <br /> VDI.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT ® 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 ❑ 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING <br /> 1995 ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑ 6.NONE 469 <br /> DC.OWNER/OPERATOR SIGNATURE <br /> I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF OWNER/OPERATOR DATE 470 <br /> 04/07/03 <br /> NAME OF OWNER/OPERATOR(print) 471 TITLE OF OWNER/OPERATOR 472 <br /> SONIA RAY COMPLIANCE SPECIALIST <br /> Pemut Number(For local use only) 473 Permit Approved(Por local use only) 474 1 Pemut Expiration Date(For local use only)475 <br /> UPCF(1/99 revised) Formerly SWRCB Form B <br />