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Aug 13 03 12:06p Richard Thompson 9226-2050 p.9 UNIFIED PROGRAM CONSOLIDATED FORM SITE #2705446 PIPING UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION ((-'hcckallthmappty) Pattie __.., of UNDERGROUND PIPING AROVF.G Oi NO PIPING SYSTEMTYPE MI. PRESSURE 02. SUCTION ❑3. GRAVrIY 458 ❑ 1. PRESSURE 1--12. SUCTION ❑3. GRAVITY 459 [I1 SINGLE WALL ❑ 3. LINED ❑ 99. OTHER 460 ❑1. SINGLE WALL C195.95. XERXES 462 _ DOUBLE WALL [:195. XERXES [12. DOUBLE WALL 099. OTMER MANUFACTURER MANUFACTURER 461 MANUFACTURER 463 ❑ 1. BARE STEEL 06. FRP COMPATIBLE wi toms METHANOL ❑ 1. BARE STEEL ❑6. FRP COMPATIBLE W/ 100'/ A OnLINOL [12. STAINLESS STEEL El 7. GALVANIZED STEEL C12. STAINLESS STEEL 07. GALVANIZED STEEL 1111 AND ❑3. PLASTIC COMPATIBLE WITH CONTENTS [J95. XERXES E] 3. PLASTIC COMPATIBLE WITH CONTE-NISE]8- FLEXIBLE (HOPE) 099. (7I HER CORROSION PROTECTION . FTBERGLASS ❑8. FLEXIBLE (IBSPE) ❑99. OTIIER ❑4. FIBERGLASS 09. CATHODIC PROTECTION ❑5. STEEL W/ COATING ❑9. CATHODIC PROTECTION 464 105. STEEL WI COATING ❑95. XERXES 465 VII. PIPING LEAK DETECTION (Check all than appy) (Ake tpn. oJthe manttorirmprogram ahaAhe 3wkwita l to the k,arl agency.) IINDF,RCROIfND PIPING AROVFGR0I IND PIPING SINGLE WALL PIPING SINGLE WALL PIPING 467 PRESSM12ED PIPING ((:hack all that apply): PRESSURIZED PIPING (Check all that apply): ❑ L 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 SYSTE161 DISCONNECTION + AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPH TEST ❑ 1 MONTHLY 0.2 GPH IS T ❑ 3. ANNUAL INTECRITY TEST (O.1 GPH) ❑ 3. ANNUAL IN EGRITYTGST(O.I GPIO ❑ 4. DAILY VISUAL CHECK CONVENTONAL SUCTION SYSTEMS (Check all Mal apply): CONVENTIONAL SUCTION SYSTEMS; 1] S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM IN ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM I TRIENNIAL PIPING BYTE• GRriY ❑ 6. TRIENNIAL [NTEGRI7YTIST(0.1 GPIs) TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVTS 1N BrWW GROUND PINING): SAFE SUCTION SYSTEMS (NO VALVES 1N BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (0reck aUrhat apply): ❑ S. DAILYV[SUALMONTTORING ❑ 9. BIENNIAL INTEGRr1YTEST(O.IGPH) ❑ 9. BIENNIAL INfTEGRITYTEST(O. I GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (C'heckaU dua apphq: PRESSURIZED PIPW G ((.heck allthat 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 PLMP SHUT OFF WHEN A LEAK OCCURS (Check one) ❑ a ALTO PIMP SHUTOFF WTiEN A LEAK OCCURS ❑ h. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SERIN' �F AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ❑ 11. AUTOMATIC LEAK DETECTOR DISCONNECTION ❑ e. NOAUIOPUMPSHUrOFF ❑ 12 ANNUAL INMGRf1YTEST (O.1GPH) I AUTOMATIC LINE• LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR SCCIIONIGRAVCIY SYSTEM: RESTRICTION E] 12ANNUAL INTEGRITY TEST (01GPH) ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS SUCTION'VGRAVITY SYSTEM: EMERGENCY GENERATORS ONLY (C'heckallthat app&) ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR W 177i.O..UT ALPO PULP SHITI'OFF . AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all Mai apply) ❑ 15. AUTOMATIC LINE LEAK DEIECIOR(3.OGPH TEST) ❑ 14 CONTINUOUS SUMP SENSOR W rrT-10(IT AUTO PUMP SHUTOFF + AUDIBLE AND ❑ 16. ANNUAL INTEGRRYTEST (O.1GPH) VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WfTI IOill FLOW SHUT OFF OR ❑ 17. DAILY VISUAL CHECK RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST (a. I GPH) ❑ 17 DAILY VISUAL CHECK VITT. DISPENSER CONTAIN M ENT ❑ 4. DAILY VISUAL CHECK DATE INSTALLED 468 2 CONTNUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER/ MONITORING ❑ I CONTINUOUS DISPENSER PAN SENSOR W 17T( AUTO SHUTOFF FOR DISPENSER AUDIBLE AND VISUAL ALARMS ❑ 6. NONE 469 IX. OWNER/OPERATOR SIGNATURE I cerih, that the information Provided herein is ttuc and wcurnte to the best of my Imowkdge. SIGN, FOWN PERATOR DATE ` 470 l NAME O N R/OP TOR (print) 471 TITLE OIF( PERATOR 472 JANETT M. TH0111PSON FOR CIRCLE K STORES, INC. ENVIRONMENTAL COMPLIANCE SPECIALIST Permit Number (For local ase only) 473 Permit Approved (For kcal au only) 47; Permit Expiration Date (Far k cal use only) 475