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05/20/2004 09:25 7074464Q CAL INC PAGE 04 ITNIVIVD VRt'V'.VATi/r 1 nN4.Qnr.MATFD VC)UM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE Z Page 2 of 2 UNDERGROUND PIPING A130VEGR0UND1'B3WG - SYSTMTYPE El I.PRESSURE 0 2,SUCTION ❑3,3MVITY 438. PRESSURE 01SULTION Q1.GRAVITY 459. CONSTRUCTION/ Q 1.SINGLE WALL 0 a,J,INWD TRENCII 0 99 OTREF 460, ❑I.SINGLE WALL E3 95.UNKNOWN 442. MANUFACTURER 912.DOUBLE WALL [3 95.UNKNOWN 2,DOUBLE WALL L3 99.OTHER MANUFACTURER'Unkirlown 441- MANUFACTURER UnklIOWn 463 ❑1,BARE STEEL 0 6.F"COMPATIBLE WI)On%METHANOL ❑1.BARE STEEL a 6.FRP COMPATIBLE WIIWI.METHANOL [32,STAINLESS STEEL Q 7.0ALVANT7,330 STEEL p 2,STAINLESS STEEL 0 1.OALVANIZED STEEL 0 3.PLASTIC COMPATIBLE WITH CONTENTS 0 95,UNKNOWN 0 3.PLASTIC COMPAT03LEW/CONTENTS 118-FLEXIBLE CWPE) 0 99,OTREP OR 4.FIBERGLASS [3 8,FLEXIBLE(HDPE) 1199.OTHER 19 4.VIBERGLASS [19,CATHODIC PROTECTION E3 5.STEEL W/CGATING 0%CATHODIC PROTECTION 4" Q s.STEEL WiCOATING 0 95,UNKNOWN 45. UNDFRGPOUNJD PIPING ABOVEO)KOLNO PTPN0 SINGLE WALL PIPING 466, SINGLE WALL PIPING 467. PRESSURIZED PIPING(Check W1 that VPIY)-' PRESSURIZED PIPING(C4mk all that apply.l: 0 I. ELtCTRuNIC LINE LEAK DETECTOR 3.0 OPH TEST AUTO PIM 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 01'14 TEST WITH AUTO VUNg' SIIIJT-OFF FOR LEAK,SYSTEM FATTATRF,AND SYSTEM DISCONNECT ION SHUT OFF FOR LEAK,SYST84M FAILURE,AND SYSTEM DISCONNECTION �AUDIBLE AND VISUAL ALARMS. 4-AUDIBLE AND VISUAL ALARMS. 02. molrmlf 0.2 03,11 TEST E3 2. MONTHLY 0.2.CV11 TEST [13. ANNUAL INTEGRITY TEST(0.1GPH) 0 3, ANNUAL INTEGRITY TEST(0.1 OPH) [34. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chunk oil that apply) Cls. DAILY visuAL MONITORING OF PUMPING SYSTEM}TRIENNIAL PIE ING fj 5. DAILY VISt:AL MONITORINO OF PIPINO AND PIZOING SYSTEM INTEGRITY TEST(0.1 01`11) SAFE SUCTION SYMMS(NO VALVES IN BELOW GROUND PIPIN(3): 136, TRIENNIAL INTEGRITY TEST(0.1 OPH) M 7. SELF MONITORING SAFE SUCTION Syb7gMS(No VALVES IN BELOW GROUND PIPING): qgAVITYFLOW ®7. SELF MONITORING J39. BIBNN1ALINT9(MTYTES`r(0.10?H) GRAVITY FLOW(Check all that apply): QS, DAILY VISUAL MONITORING [39. BIENNIAL INTEGRITY TEST(0.1 OPH) SVCONDANULY CONTAINED PIPING SI&CONDARXILV CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): FRESSUMMED PIPING(Chock all dw apply); 10. CONTINUOUS TURBINE SUMP SENSOR MM AUDIBLE AND VISJAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDD31,15 AND VISUAL ALARMS AND(Check one) ALAR M$AND(Check omi) El a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS a,AUTO PUMP SHUT OFF WHEN A LEAK OCCURS El b.AUTO PUMP SHUT OFF FOR LAAKA,MTTU FAILURE AND SYSTEM ❑b,AUTO PUMP SMT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION 0,- NO AUTO PUMP SHUT OFF 0o, NO AUTO PUMP SHUT OFF ❑11, AUTOMATIC LINE LEAK DETECTOR(3,0(3PJJ TEST)WITH FLOW SHL'[ Ej i i.AMMATIC LEAK DETECTOR OFF 09 RESTfurUrION [112. ANNUAL INTEGRITY TEST(0,1 GPM El 12.ANNUAL INTEGRITY TEST(91 GPII) SUCTIONIGRAVITY SYSTEM SUCTIOT41(;RAVITY SYSTEM 0 15. CONTINUOUS SUMP SENSOR+AUDIBLE AND VT911AL ALARMS 0 m CONTINUOUS SM&SENSOR+AUDIBLE AND VISUAL ALARMS XMEWGENCV(,9NERATORS ONLY(Check all that spplY) EMERGENCY GENEIWI-ORS ONLY(Check all that apply) [114, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 4.CONMNUOVS SUMP SIWSOR MIQ=AUTO PUMP SHUT OFF A'JbIuLr- AND VISUhI.ALARMS ALID)BtE AND VI1,;UAI.ALARMS [315. AUTO.-4ATIC LM LEAK DETj3CTOR1 (3.0 0Pjj TEST) WITHOUT FLOW 0 is.AUTOMATIC LINE LFAX DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION 0 16, ANNUAL INTEGRITY TEST(0,1 GM) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) [117. DAILY VISUAL CHECK El 17, DAILY VISUAL CHECK DISPENSER CONTA11,04ENT 468. EI 1, FLOAT MECHANISM THAT SECTS OFF SI-MAP VALVE E3 4. DAILY VISUAL CHECK 469- DATE INSTALLED 69-DATEINSTALLED Ll 2, CONTINUOUS DISPENSER PAN SENSOR 4-AUDIALA AND VISUAL ALARMS 0 5. TRENCH/LINER MONITORING 4/2004 M 3. CONTINUOUS DISPENSER PSN SENSOR )r= AUTO SHUT OFF FOR 0 6. NONE DISPENSER+AtJ)IRLE AND VISUAL ALARMS IX.UWNER/4 PEPUATOR UG NATVA9 I certify that the information provided herep is true and accurate to the beat of ave ktowlecip. SIGNA7UIZE OF OWNERIOPERATOR470. DATE: q NAME OF OWNER/OPERATOR(prixit): A? TITLE OF QWNERIOPISILATWU 10,01'ed Acl)�Ze--CAL VVC Poxmit Numbor(Agencirwe only) 77 Parrott Approved By'.Aganoy 4ko curly) 474. 1 Peftnk EXPit2flOU Date(AgOWY bRe only) 475. UPCF hwfwrt-b(1199)-3/4 IrtipWwww.1maidomarg xzv.02/16"