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MAY-11-2007 10:20 FROM:CHOL/MFT 209 476 3096 TO:2094683433 P.4/4 ,05/10/2007 THU 15: 13 Pax. 20946 3 SJC RNO 10 21004/004 . SI itla� UniN'IEO PROGRAM Ct3NSULipA'i X11 FORM TANK: "rloza9aol CJ 141 A: PR023"94 FAC M: FAL108a60Z UNDERGROUND STORAGE TANKS-TANG{ PAGE 2 VI-PIPING CONSTRUCTION 9'kn►alaal,lnlr9 PID;)of 1 PHOER6,110UNDPIPINO ABOVEOR(k)N5WING - (/ SYS IF.M'1'YPE ❑ 1 PRL$S(WL 62.SUCTIOT# ) GRAVITY 439 ❑ 1 PRcssllRr ❑3.r5WTION ❑) GRAVITY a.s9 LONNTNUC110N d I SINGLEWAI.1. 03 1,14L'DIREN(:H Q r)OTHITR 410 ❑ 1 SINOLLWALL ❑95 UNKNOWN 462 .._._.... 5a DOULtt"F(NAI.L ❑95.UNKW)%N 0 3.Dotmu,:w.I. 1399 01 NR W: U - MANO1'1•IIit31t 461 MANUI'AC"11)RLR ((.t IVY/ ❑ I IIAIMSIRL ©G I`ItPCOMPA'171RIT.1la01#MJ'1'WAWOL ❑ I RARUS'ruli, ❑6 FRIACOMPATtut,l.niRAIIIAW tAN:k ❑3.5'rAiNLLSS 51'11L'L ❑ 7.GAL.VAN)ZGD 6WEL ©2.STAINLII,SS SW.F..I. Q 7 GALVANIZED ❑114A15TIC COMPATMLI:W CON"LNTS ❑95 UNKNOWN ❑PI.ASTIC COMPAIIIILU WIC-DWrC-NTS ❑US L.IVKNOWN ;&4 rIRLRGLASS [ 8 1'I,13XII3IX(HDPG) ©99art in( []a lIril:Rt;:l..n5$ ❑8 r•LUIOLL'(RDPE) 0 w O'tuot ❑5.STLLL 1V/(:OATING C I)CATHODIC PRO TCfION ata ❑ 5 S'i'r•FI.WICOATENO p 9 cm-amlc PRmperION VII.PIPING LEAK DETECTION(rc]akautMlRnlaL)(,wy«,n� u�0amndwl. ron�hegtrotktwmedpisl.�dn�mmcy't �,- UNDP.ROROUNU1'RRYtCi �w ___ ADOVEGROUNDMpING ~ SINGLE WA L.I.1'[PI NG arA SINGLE WALT,I'IPLN(; 417 PRIM I RIZED PIPING(Check all that apply): PIAKSSURIZED PIPING(Check All that aplilly)c �] EUiCTftONIC[.1NG 1.RAK 17F1'L'C1'Wt)U OPIr'IL'ST WI)'H AUI''U PUhIP S1:U'f OFl° ❑ I.leh(.'118f)NK;LINIi L11AK DrJL+C'IT)R 3.O C)PH 1725T.)yJ;Atl l'01'l)k11'SHUT OIF FOR LEAK,SYS T@M)AW091b,ANI)SYS'ET:M DISCONISEv•ION'AWAULE AND TOR I_rAK.SYS`i w FAILURE ANDSYSTFAI FASCONNL'CCION+AUDI))LF AND VISUAL ALARMS. V ISLIAL AL "IS. ❑ :MMTHI.Y A 7 GP11 TEs-r C3 2 MON'ttli-Y 0 Z GPII TMT ❑.1 ANNUAL INTROIU'TY I VST(0 I Gr1U ❑3 ANNUALIWF.CiRiTYTESi-10I(.Pit) ❑4 DAII-YVISUAI.C7116CK CONVENTIONAL SIJC"fION SYSI'GMS CONVIWI llONAI.SUC1710N Sl'$'I 4bliS(C'Fv(vh all that apply) p 5 PP'ENG a S DAILYYTSLALMONITORIN(i011PI14NOAND MJhIP)N4'SYSI'LM INTEGRITY TIST(0 i OPH) ❑6 'IIIII3.I1,11AL INTI$iRITYI"F.ST(0 I Gnit) SAFF.SUCTION SYSTEMS(NO VAIMIUS IN(IF.LOW GILOUND?tPINCy: SAFF SUCTION 5111IMMS(NO VALUIdS IN t►F'3A)W A['a(OI.NIW I PING): ❑7.SGLF MONI)'OR1N(. ❑ 1 SLu.,MONITORING GRAVITY FLOW ❑9HIFNMALIN'rr.CKiTyrFS'r(6.1)CFMI URAV11YFLOW(Check alltkmtapp(y)l ❑ R [JAIL Y V ISUALMONITORWO ❑ 9 IIILNNIALINTI(iR),rY'r1tST(O.i)(jPII $WONDAR(LYCONI'AINFO PIPINC SlIXONDARILV CON'1'A/NEII PIPING PU SSURIM)PIPING(Ckaekalltkat apply)( PRRSSI)RM'Fill pU'INC(Chw&aUtkat apply} 10 CON 1INl(JUS 1'UR0INL SUMP SUNIMI WETLI Atfl.*0-0,AND VISUAL 10.CONTINI„t)US rUKIIINESUMPSGNSOR Wim(AUDIULL'AND VISUAL ALARMS AND lC hmL-cuw) ALARMS AND(Chak an'. ❑a AU'T'O IKJ4IP SItUT Opr WHGN A LPAK OCCIMS C a AUTO PUMP SIiumpP WHEN A LEAK OCCURS h AUl'O PUMP Sl11.1'I'UPF FOR I 1-1-AKS.SYS'Ii:M %Nil3Nsf E I%nEt.U;itc, lm MS n Ib.)SCON INJMP SIIItT OFT rOR.I F.AkS,SYS'I'L'M FAILU[Ui ANO NYS7riM DISCON1,111C ION CCNJNL'C'r10N 1j C NU AUTO PUMP SI IUr OFF [E a NO AU`IU PUMP SRUJ Orr ❑ 11 AGI"DN1A'I ICI.INH l.I:Ak I)PTHC'1'0k la.00WII I EST)Wrrri Fl_OWSEIUTprl,oR 11 AU i-omx C'LUAK IM-ECCOR RL•'SYRiCTION ❑ 12 ANNUAL INTUORITYTf NT(6 1 GPH) ❑ 11 ANNIIALIN'Pr,GkiTYTFiST(0.I(ieri) NIH'TI0?WGRAVl PW ATS1'KM SLCTION/GRAV11'Y SYSTEM ❑ 13 CONI INLKJOS Sl MP SENSOR l*AUDIBLE AND VIS(JALAU%RMS ❑ 13 CON'IINUO(ISSUMP SENSOR«AUOIOLL AND YISUAL ALARMS t's11*69.NCYGENERATORS ONLY F.ML1111G NCYGENP.RA'1(.tltSUNLY(C1wakallAmapW}) ❑ 14 CON'1'INI1pl1SNUM PSF:Ny011wI'I71AU'I"AVID PUMPSH(JTOFF• Q 14 CUNrINUOLMSUMP SENSORd(I;fl; t11;AlJTOP(INtPSHUT019: ALUIULLAND VI.4)AI.ALARMS AUDLILLL,AND WAIAL A(.'1khLs U 15 AUIOM.4'I'IC'LINE LEAK DETIi(,.Wit 0.0GPII FLSf)WIrl1OU I'LOW ❑ fS.A(?i(;.NAI'I(:LINr•LEAK 1]rTIECr'OR(;(OC(I'H 1'FSI)WI'YPKkii'i%LOW SHUJO:T OR RPSTRIC T ION SNUY OFF OR RF.S'i-RICTION [, 14 ANMJAL Irl LGRI I`Y I Isi.(0.1 GFtl) ❑ 6.ANNI JAI"IMII!G$1TY fl-'S I(0.i(il'1t) p 17 DAD•YVl15LAE.clt1.CK C7 17 DAILY VNIJAI.CHECK VIOL p1SP1(NS ER GO�ITA tNM it N'i' 015PURSLRCONTAINMr:Nr a.13-I,F1„OAtMLCIIANISh1'11IAJ'SHUINOtI`SlIVAI(vALVIi --_• ❑•4 DAILY VISUALC116fK UATE iN5 rALLEiI) 4110 ❑2.CON'rfNUGIA 1ASPliN3Eit PAN SF•N50R*AUDIBLE AND VISUAL AIAIthfS [J.S 1"RI:NCti LINF,R/MONITORING ❑7 CONILNUO11SDL5PPNSERPAN srmamwrilAU'Ib51111'POFTrC)it ❑6.NONE DISPENSER P AUDIRWAND VISUAL ALARMS -10 DL.OWNER/OPERAT01i SIGNATURE I H11111)aNi Ih"alFM11'Iftn ofov w N14.w Ua8 and 4xmmle W IN XI Rf t"�kaW1'IR117C SItiNAl11R1iO�;X E1j/O )� �- DA'IU NAMLOFOWNEK;OI":A11 (.4111L) - 01 'ITI'LL.OFOWNL'MPER TOR 412 IMrnn 473 ROW AA-4WN W-0me M10 474 ft-k L`.wWhw D+Ic IFos kcd uss PA) 471 PT0002593 21:0000817 12/31/2007 12:00.00AM U11CF(12N9 rrvised)