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IFIED PROGEAM C,ONSOLIDATED FOR bi TANKS UNDERGROUND STORAGE TANKS - TANK PAG VL PIPING CONSTRUCTION(Check all that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE X 1. PRESSURE r 2. SUCTION r 3. GRAVITY r 1. PRESSURE r 2. SUCTION r 3. GRAVITY 459 CONSTRUCTION r 1. SINGLE WALL r 3. LINED TRENCH F99. OTHER r 1. SINGLE WALL F95. UNKNOWN 462 1 X 2. DOUBLE WALL r 95. UNKNOWN r 2. DOUBLE WALL r 99. OTHER MANUFACTURE R MANUFACTURER 461 MANUFACTURER 463 F 1.BARE STEEL r 6. FRP COMPATIBLE W/100%METHANOL r 1. BARE STEEL r 6. FRP COMPATIBLE W/100%METHANOL MATERIALS AND r 2. STAINLESS STEEL r 7. GALVANIZED STEEL r 2. STAINLESS STEEL r 7. GALVANIZED STEEL CORROSION PROTECTION r 3. PLASTIC COMPATIBLE WITH CONTENTS r 95. UNKNOWN r 3. PLASTIC COMPATIBLE WITH CONTENTS r 8. FLEXIBLE(HDPE) f"99. OTHER X 4. FIBERGLASS IF 8. FLEXIBLE(HDPE) r 99. OTHER r 4. FIBERGLASS r 9. CATHODIC PROTECTION r 5. STEEL W/COATING r 9. CATHODIC PROTECTION 464 r 5. STEEL W1 COATING r 95. UNKNOWN 465 VII.PIPING LEAK DETECTION(check all that apply)(A description of the monitoring program shall be submitted to the focal agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): F 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 r 2. MONTHLY 0.2 GPH TEST r 3. ANNUAL INTEGRITY TEST(0.1 GPH) r 3. ANNUAL INTEGRITY TEST(0.1 GPH) f 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that apply): r 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): F 9. BIENNIAL INTEGRITY TEST(0.1 GPH) F B. DAILY VISUAL MONITORING r 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(check one) F a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS r a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS X 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 F c. NO AUTO PUMP SHUT OFF r c. NO AUTO PUMP SHUT OFF X 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR r 11. AUTOMATIC LEAK DETECTOR RESTRICTION rI 12. ANNUAL INTEGRITY TEST(0.1 GPH) 12. ANNUAL INTEGRITY TEST(0.1 GPH)R' SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: F 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 T 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUAL ALARMS ALARMS r 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 F 16. ANNUAL INTEGRITY TEST(0.1 GPH) r 16. ANNUAL INTEGRITY TEST(0.1 GPH) F 17. DAILY VISUAL CHECK r 17. DAILY VISUAL CHECK Vlll.DISPENSER CONTAINMENT DISPENSER CONTAINMENT r 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE r 4. DAILY VISUAL CHECK DATE INSTALLED 468 r 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS f 5. TRENCH LINER/MONITORING 1998 X 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS r 6. NONE 469 IX 0WNFRlQPFRATQR.RIr.N1ATIIRF I certify that the information provided herein is true and accurate to the best of my knowledge SIGN U E]F�OWNERATO DATE � /O 3 470 4/27102 NAME OF OWNER/OPERATOR(print) 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 6