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Rug 13 03 12:O8p R ' and Thompson 9226-2050 p.11 UNIFIED PROGRAM CONSOLIDATED FORM SITE #2705446 PIPING UNDERGROUND STORAGE TANKS - TANK PAGE 2 VL PIPING CONSTRUCTION (l'hecha!lrhatappry) Page - of IINDF.RGROIINDPIPING ABOWGROIND PIPING 1SYSTEM TYPE ®1. PRESSURE ❑2. SUCTION ❑3. GRAVITY 458 ❑1. PRESSURE ❑2. SUCTION ❑3. GRAVITY 459 SINGLE WALL ❑ 3. LINED TRENCH ❑ 99.OTI[ER 460 ❑ 1. SINGLE WALL ❑95. XERXES 462 CONSTRLtC170N1 MANUFACTURER ,O11BLE WALL ❑ 95. XERXES ❑2. DOUBLE WALL [199. OTHER MANUFACTURER 461 MANLTACIURER 463 1. BARE STEEL ❑6. FRP COMPATIBLE wt tam. METHANOL Ell. BARE STEEL ❑6. FRP COMPATIBLE W/ ]00°i6METHANOL [12. STAINLESS STEEL 07. GALVANIZED STEEL 02. STAINLESS STEEL F-1 7. GALVANIZED STEEL MATERIALS AND 95. XERXES C13.CORROSION 3• PLASTIC COMPATIBLE WTTII CONTENTS [395.3 ❑. PLASTIC COMPATIBLE WITH CONTENTS ❑8. FLEXIBLE (FIDPE) [199. OTHER PROTEC-RON 4. FIBERGLASS ❑8. FLEXIBLE (HOPE) 099. 0T11ER ❑4. FIBERGLASS ❑9. CATHODIC PROTECTION ❑5. STEEL W/ COATING ❑9. CATHODIC PROTECTION 464 ❑5. STEEL W/ COATING ❑95. XERXES 465 VII. PIPING LEAK DETECTIONpitacruthatoppry)(Adescrtptianajthemonito)ingprr,gmm.: mheauhmittedtothekcalagency.) IINDFRrR I3ND PIPING ABOVECROI TND PIPING SINGLE WALL PIPING SINGLE WALL PIPING 467 PRESSURITFD PIPING (Checkall that appy): PRESSURIZED PIPING (Check ala that apply): ❑ 1 L.LECTRONIC LN -E LEAK DETECTOR 3 0 GPH TEST wrTH AUID Ptimp SHUT OFF FOR ❑ I ELECTRONIC LTNE LEAK DETECTOR 3.0 GPH TEST W DH AUTO PUMP SHUT OFF FOR LEAK LEAK, SYSTEM FAILA RE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPH TEST ❑ 2. MOMNLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0. I GPH) ❑ 3. ANNUAL INTEGRITY TTST(0. 1 GPH) ❑ 4. DAILY VISUAL CHECK CONVEMTONAL SUC'ITON SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Checkall chat appy): ❑ S. DAILYVISL'.ALMOTvTTURMGOFINPINGANDPUMPINCSYSTL•'W ❑ 5 DAILY VISUALMONITORINGOFPUdPINGSYSIENT+TRIENMALPIPINGIMEGRTTY ❑ 6. TRIENNIAL INTEGRITY TEST (0.I GPH) TEST(0.I GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING) ❑ 7. SELF MONTIIORING ❑ 7 SELF MONITORING GRAVfN FLOW: ❑ 9. BIENNIAL INIFGRIIYTEST I GPH) GRAVITY FLOW ((:luck all rhm appy): ❑ 8. DAILY VISUALMONITORING (O. ❑ 9. BIENNIAL INTEGRITY TEST (0. I GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRFSSLRIZFD PIPING: (Checi all that appy): PRESSURIZED PIPING (CheckaL rhat apply): 10. CONTINUOUS TURBINE SUMP SENSOR'%VMi AUDIBLE AND VLSUAL ALARMS AND (check one) 10. CONTINUOUS TURBLV E SUMP SENSOR WTITi AUDIBLE AND VISUAL ALARMS AND ❑ A(Hp PUMP SHUT OFF WHEN A LEAK OCCURS (Chale one) ❑ A1J10 PUMP SHUTOFF WHEN A LEAK OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DLSCONNEcnON ❑ c. NO AUTO PUMP SHUTOFF . ALTO PUMP SHUTOFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ❑ 11. AUTDNL\TIC LEAK DETECTOR DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ 12. ANNUAL INTEGRITY TEST (O.I GPH) 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLAW SHUT OFF OR SUC710N7GRAVTIYSYSTEM RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST (o.I GPIs) .. ❑ 13. CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL ALARMS SUC TIONIGRAVRY SYSTEM: EM ERG ENCY GENERATORS ON LY (Check aR rhar appy) ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS ❑ 14. CONTINUOUS SUMPSENSORWPilaO1JTALTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check allihatappl)) ❑ 15. ALITGMATICLINE LEAK DETECTOR (3.0GPHTEST) ❑ 14. CONTINUOUS SUMP SENSOR WfIHOUTAUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS ❑ 16. ANNUALINIE•GRITYTEST(O.IGPH) ❑ 15. AUTOMATIC LINE- LEAK DETL•CR)R (3.0 GPH TEST) WITITOTII'FLOW SHUTOFF OR ❑ 17. DAILY VISUAL CHECK RESTRICTION ❑ 16. ANNUAL INTEGRITY TCST(O I GPH) ❑ 17. DAILY VISUAL CHECK AIN M ENT ❑ 4. DAILY VISUAL CHECK OATEINSTALLED 468 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER/ MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR wnH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS ❑ 6. NOV E 469 IX. ONVNER/OPERATOR SIGNATURE I ecnify that the ilftamation piSvj&d berein is true and aeaaate to the best of my knowledge. at SIGN WN t ATOR DATE 470 _R .,. NAME OF ER/OPERATOR (prino 471 TITLE O 472 JAN:- Tr'. THOMPSON FOR CIRCLE K STORES, INC. ENVIRONMENTAL COMPLIANCE SPECIALIST Perm4 Number ()r,r k)owl tew aaty) 473 P -d Approved (Poor kurd uw only) 474 1 Permit Expiodi- D t. (r,r!neat ane mete) 475