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Rug 13 03 12:09p R' hard Thompson 92226-2050 P.13 UNIFIED PROGRAM CONSOLIDATED FORM SITE #2705446 PIPING UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION ((7--Aallrinlapply) Paye of UNDERGROUND PIPING AROVEGROtIND PIPING SYSTEM TYPE ®1. PRESSURE 02. sLic TON 03. GRAVITY 458 [11. PRESSURE ❑2. SUCTION ❑3.ORAVITY 459 [11. SINGLE WALL ❑ 3. LLNEDTRENCH [:199. OTHER 460 01. SINGLE WALL ❑95. XERXES 462 CONSTRUCTIOW ❑ 2. DOUBLE WALL ❑ 95. XERXES E:12. DOUBLE WALL C199. OTHER MANUFACTURER MANUFACTURER 461 MANUFACTURER 463 ❑ 1. BARE STEEL 06. FRP COMPATIBLE wv iom METHANOL ❑ I. BARE STEEL G. FRP COMPATIBLE W/ 100%METHANOL STAINLESS STEEL El 7- GALVANIZED STEEL 02. STAINLESS STEEL ❑7. GALVANIZED STEEL MATERIALS AND[12. CORROSION ❑3. PLASTIC COMPATIBLE WITH CONTENTS 095. XERXES ❑3. PLASTIC COMPATIBLE WITH CONTENTS ❑8. FLEXIBLE (HDPE) 099, OTHER PROTECTION ❑4. FIBERGLASS Q8. FLEXIBLE (HDPE) ❑99.OTTTER 04. FIBERGLASS 09. CATHODIC PROTECTION 05. STEEL W/ COATING 09. CATHODIC PROTECTION 464 Q5. STEEL W/ COATING ❑95. XERXES 465 VILPIPING LEAK DETECTION (Checkallthatapply)(Ade&arptionrrfthemaniloringpmt &holtbemhmiuedmrkeloco/agency.) IINDERGROIIND PIPING AROVFCROIFND PIPING SINGLE WALT. PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING (Checka8 char al ph); ❑ PRESSl1R IZM PIPING (Check aUfAat apply): 1. ELECTRONIC LINE LEAK DETECTOR 3.00PH TEST WITH AMO PUMP SHUTOFF FOR ❑ I, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESTNTT H AUTO PUMP SHUT OFF FOR LEAK, j LEAK SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNEC7ON+AUDIBLE AND VLSUALALARMS ALARMS ❑ 2. MONTHLY 0.2 GPH TEST ❑ 7 MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 3. ANNUAL INTEGRITY TEST (G. I GPH) ❑ 4. DALLY VISUAL CHECK CONVENTIONAL SUCION SYSTEMS, CONVENTIONAL CONVENTIONAL SUCTION SYSTEMS (C7reck alllhar apply): S. DALLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 5 DAILY VISUALMONITORING OF PUMPING SYSTEM+TRIE•NNIAL PIPING INTEGRITY ❑ 6. TRIENNIAL INTEGRTIY71S7•(O.IGPH) TEST(O.IGPH) SAFE SLY.TION SYSTEMS (NO VALVES IN BELOW GROUND PIPING} SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING)• ❑ 7. SAF MONITORING ❑ 7. RELY, MONITORING GRANTIY FLOW: GRAVITY FLOW Klock all drat appty): 0 9. D1P.NNIALINIEGRr1YTESf(0.IGPIi) ❑ 8. DAILYVISUALmoNIORING ❑ 9. BIENNIAL INTEGRITYTEST(O.I GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZEDPLPING (0w*aBihatapply): PRESSURIZED PIPING ((:Beck all th.1 apply): 10. CONTINUOUS TURBINE SUMP SENSOR W'RN AUDIBLE AND VISUAL ALARMS AND 10 CONTINUOUS TURBINE SUMP SENSOR WMj AUDIBLE AND VISUAL ALARMS AND (check one) ❑ AUTO PUMP SHUTOFF WHEN (Check one) ❑ a_ AUTO PUMP SHUT OFF WHEN A LEAK OCCURS a A LEAK OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE A\b SYSTEM DISCONNECTION ❑ b. AUTO PUMP SHUTOFF FOR LEAKS, SYSTDA FAILURE AND SYSTEM ❑ c. NO AUTO PUMP SHUTOFF DISCONNECTION ❑ II. AUTtOMAmc LEAK DETECTOR I ❑ c. NO AUTO PUMP SHUT OFF ❑ 12. ANNUAL INTEGRITY TTST (0.1 GPH) ❑ Il_ AUTOMATIC LLVELEAK DETECTOR (3.0GPH TEST)) )M FLAW SHUT OFF OR ON RFNT Sll('npNiGRAVfTYSYSIEM: Q 12 ANNUALNNUAL LNTEGRf1YTEST(0.1 GPH) ❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS SUCTION/GRAVITY SYSTEM. EM ERC. ENCY GENERATORS ON LY (Uhrck aANwt apply) ❑ 13, CONTINUOUS SUMP SEMR+ AUDIBLE AND VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WfIHOUC AUTO PUMP SHUT OFF +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(ChcckatlrharoppfyJ ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.OGPH TEST) ❑ 14.COMINUOUSSUMP SENSOR WIHOUTAUTOPUMP SHUT OFF +AUDIBLE AND VISUAL ALARMS ❑ 16. ANNUAL INIE•GRITYTEST(O. I GPH) ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WI1HOl1T FLOW SHUT OFF OR ❑ 17. DAILY VISUAL CHECK RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPM ❑ 17. DAILY VISUAL CHECK M1t ENT DISPENSER CONTAINMENT 1. FLOAT MEC14ANISNI THATSHUIS OFF AEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+ AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER i MoNIOR1NG ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ AUDIBLE AND VISUAL ALARMS ❑ 6. NONE 469 IX. OWNERIOPERATOR SIGNATURE 1 cal)fjqhat the information pmsided herein is true and actuate to the best of my knovdcdye. S A OAF O 0tAATOR YID r DATE 470 TITLE O • NFR/OPERATDR 472 NAME WNERIOPERAIDR prior) 471 If JANETFE M. THOMPSON FOR CIRCLE K STORES, INC. ENVIRONMENTAL COMPLIANCE SPECIALIST Permit Number (Forlocal ttmonly) 473 Permit Approved (Far kcal meanly) 474 1 Permit Expiation Daft (For kcal rc c only) 475