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UNIFIED PROGRAM 707SOLIDATEDWIRM TANK r 1 UNDERGROUND ST®RAGE TANKS - TANK PAGE 2 111, VI.PIPING CONSTRUCTION Check all that a ty2 Page of UNDERGROUND PIPING ABOVEGROUND PIPING SYS"17EM TYPE ®1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 4.58 ❑1.PRESSURE ❑2. SUCTION CONVIR(1C110N ❑L SINGLE WALL El 3 GRAVITY 459 ❑3 LINED TKENCIi ❑99.01'ITER 460 ❑1.SINGLFi WALL ❑95_UNKNOWN 402 MnNUFACTURI:R ®2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER TELEFLEX 461 MANUFACTURF,R El 403 1.BARE STEEL ❑6.FRP COMP=w/100% METIIIANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE W/100%METHANOI. 2.S'I'A[NhESS STEEL ❑7.GALVANnknown ❑2. S"IAINLESS ST'fila. ❑7.GALVANIZI D S'FEiIiI.❑3_PLASTICCOMPATIBLE W/CONTENT . Other ❑3. PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HI)PI) ❑99. OTHER®4-FIBERGLASS ❑8.FLEXIBL ❑4_ FIBERGLASS ❑9 CATHODICPROTECTION❑5.STEEL W/COAT'ING ❑9.CATHOD464 ❑5. STEEL W/COATING ❑95.UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that apply)(A description of the mond ming program shall be submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 rPRESSSURIZEDPING(Check all that apply): PRESSURIZED PIPING(Check all that a IPP Y)C LINE LEAK DEFECTOR 3-0 GPH TESTWIT 3 AUTO PUMP SHUT ❑i. ELIiCTRONIC LINE LEAK DETECTOR 3.0 GPH"LOSTWITH AUTO PUMPAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDI LE AMS VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH T'E'ST' ❑2. MONTHLY N0. GPHIS TEST ❑3.ANNUAL INTEGRITY'CIsST(0.i GPH) ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL STICTION SYSTEMS CONVENTIONAL SUC'T'ION SYSTEMS(Check all that a ❑5.DAILY VISUAL MONITORING:Oh PUMPING SYSTEM+TRIENNIAL PIPING apply) INTEGRITY TEST(0.I GPH) ❑5. DAILY VISUAL MONITORING OF PIPING AND PIMPING SYSTEM SAFE,.SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6. TRIENNIAI,INTEGRITY TEST(0.1 GPH) ❑7 SELF MONITORING GRAVITY FLOW SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑7. SELF MONITORING ❑9.BIENNIAL INTF,GRIT'Y TEST(0.1 GPII) GRAVITY FLOW(Check all that apply): ❑8. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY T'ES'T(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURI'ZE'D PIPING(Check all that apply) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10- CONTINUOUSTURBINE SUMP SS y) ALARMS AND(Check one) ENSOR W[Tt_I AUDIBLE AND VIS(IAL ALARMS AND(Check one) ❑a. AUTO PUMP SfRJT OFF WHEN A LEAK OCCURS ❑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 SYST'E'M ®c. NO AUTO PUMP SFICJT OFF DISCONNECTION ❑c NO AUTO PUMP SHUT OFF ®11 AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST')WITH FLOW SHUT OFF OR RESTRICTION ❑11. AUTOMATIC LEAK DETECTOR ®12. ANNUAL 1NT'sGRITY TEST(0.1 GPH) ❑ 12. ANNUAL INTEGRITY TEST(0.I GpI1) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF* PI Y) AUDIBLE AND VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF* ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPEI TEST)WITHOUT FLOW AUDIBLE AND VISUAL ALARMS SIU`I'OFF OR RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0.1 GPII) ❑17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ® L FLOAT MECHANISM THATSHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTALLED 468 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑3.CONTINUOUS DISPENSER PAN SENSOR WITHAUI'O SHUT OFF FOR ❑S.TRENCH LINER/MONITORING 1918 DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6.NONE 469 IX.OWNF.R/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. SI' TURE FWOPPRATOR PDATEb Q 470 NAME OF OWNER/ PRATOR(print) SANDY EDWARDS E OF OWNER/OPERATOR J , 472 Pemhit Ntunber(For local use only) 473 C J ' Pentut Approved(For local use only) Permit Expiration Date(For harAl use only) 475 UPCF(1/99 revised) Formerly SWRCB Form B