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'WaF IED PROGRAM CONSOLIDATED FVM SITE#255886/5886 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all that apply) Page of UNDERGROUNDPIPING ABOVEGROUND PIPING SYSTEM TYPE ®I.PRESSURE ❑2.SUCTION [:13.GRAVITY 458 ❑1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 459 [:11.SINGLE WALL [13.LINED TRENCH ❑99.OTHER 460 ❑1.SINGLE WALL ❑95.XERXES 462 CONSTRUCTION/ ®2.DOUBLE WALL [:195.XERXES ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER MANUFACTURER 461 MANUFACTURER 463 ❑1.BARE STEEL ❑6.FRP COMPATIBLE w/too^/.METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL CORROSION ❑3.PLASTIC COMPATIBLE WITH CONTENTS ❑95.XERXES ❑3.PLASTIC COMPATIBLE WITH CONT'EN'TS ❑8.FLEXIBLE(HDPE) ❑99.OTHER PROTECTION 04.FIBERGLASS ❑8.FLEXIBLE(HDPE) E399.OTHER ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 464 ❑5. STEEL W/COATING ❑95. XERXES 465 VII.PIPING LEAK DETECTION(Check all that apply)(T description ofthe monitoring program shall be suhmitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): ❑ 1. 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, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2.MONTHLY 0.2 GPH TEST ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS(Check all that apply): CONVENTIONAL SUCTION SYSTEMS: El DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY [1 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW(Check all that apply): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) ❑ 8. DAILY VISUAL MONITORING ❑ 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(check one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS (Check one) ElEl a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ® b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ a NO AUTO PUMP SHUT OFF DISCONNECTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ c.NO AUTO PUMP SHUT OFF ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) ® 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION SUCTION/GRAVITY SYSTEM: ® 12.ANNUAL INTEGRITY TEST(0.1 GPH) El13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS SUCTION/GRAVITY SYSTEM: EMERGENCY GENERATORS ONLY(Check all that apply) ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ALARMS ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR ❑ 17. DAILY VISUAL CHECK RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ® 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4.DAILY VISUAL CHECK DATE INSTALLED 468 ❑ 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING 1995 ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑ 6.NONE 469 D{.OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF OWNER/OPERATOR DATE 470 04/07/03 NAME OF OWNER/OPERATOR(print) 471 TITLE OF OWNER/OPERATOR 472 SONIA RAY COMPLIANCE SPECIALIST Permit Number(For local use only) 473 Permit Approved(Por local use only) 474 1 Permit Expiration Date(For local use only)475 UPCF(1/99 revised) 0 Formerly SWRCB Form