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'WCONSOLIDATED FORNO TANK:N IFIED PROGRAM CONSOLID . TA0108105PR#; PR0231094 FAC#: FA7 UNDERGROUND STORAGE TANKS -TANK PAGE 2 000644 VI.PIPING CONSTRUCTION(Check all that apply) Pageo f 7 UNDERGROUND PIPINfj ABOVEGROUND PIPING SYSTEM TYPE X 1.PRESSURE [1 2.SUCTION 0 3.GRAVITY458 ❑ 1.PRESSURE 0 2.SUCTION ❑ 3.GRAVITY 459 CONSTRUCTION El 1.SINGLE WALL 03.LINED TRENCH ❑99.OTHER 46o El 1.SINGLE WALL C]95.UNKNOWN 462 2.DOUBLE WALL n95.UNKNOWN 0 2.DOUBLE WALL ❑ 99.OTHER MANUFACTURER461 IKI MANUFACTURER 463 F1 1.BARE STEEL ❑ 6.FRP COMPATIBLE wi 100%METHANOL 1.BARE STEEL 0 6.FRP COMPATIBLE wr too-%METHANOL n 2,STAINLESS STEEL F1 7.GALVANIZED STEEL ❑ 2.STAINLESS STEEL [:1 7.GALVANIZED STEEL F n PLASTIC COMPATIBLE W/CONTENTS n 95.UNKNOWN -1 PLASTIC COMPATIBLE W/CONTENTS ❑ 95,UNKNOWN 4.FIBERGLASS f-18.FLEXIBLE(HDPE) n 99.OTHEJR ❑4.FIBERGLASS F18.FLEXIBLE(HDPE) 0 99.OTHER 5.STEEL WICOATING n 9.CATHODIC PROTECTION 464 n 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 465 VII.PIPING LEAK DETECTION(Cluck ail that apply)(A description of fie muitoring program shall be submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): n LELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. n 2.MONTHLY 0.2 GPH TEST ❑ 2.MONTHLY 0.2 GPH TEST E] 3.ANNUAL INTEGRITY TEST(0.1 GPH) n 3.ANNUAL INTEGRITY TEST(0.1 GPH) n 4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS(Check all that apply) CONVENTIONAL SUCTION SYSTEMS n 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING INTEGRITY TEST(0.1 GPH) []6,TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOWGROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): [] 7.SELF MONITORING n 7.SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check all that apply): n 9.BIENNIAL INTEGRITY TEST(0.1)GPH n 8.DAILY VISUAL MONITORING n 9.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply)- PRESSURIZED PIPING(Check all that apply): 10,CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND ALARMS AND(Check« ) F1 2.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS C]..AUTO PUMP SHUT OFF WHEN A LEAK OCCURS n b.AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM 'PrIIt.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION n c.NO AUTO PUMP SHUT OFF E]c. NO AUTO PUMP SHUT OFF 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR 11.AUTOMATIC LEAK DETECTOR RESTRICTION 12.ANNUAL INTEGRITY TEST(0.1 GPH) F1 12.ANNUAL INTEGRITY TEST(0.1 GPH) S SUCTION/GRAVITY SYSTEM UCTIONIGRAVITY SYSTEM C3 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS E] 13,CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Chk ait that apply) 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF* f-I 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF* AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION n 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE E]4.DAILY VISUAL CHECK DATEINSTALLED 468 n 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS F1 S.TRENCH LINER t MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I certify that the infematim provided herein is anre and accurate to the best of my kamie*- - SIDATE 470 I],NA 7T '330"OF OWNER/Ol oor TITLE OF OWNER/OPE 0 472 1001/'Pz Nf;it�O�WNER/OP 7. ot PermhNuniba(For lmal only) 473 Permit Approved(For kc-al use orJy) 474 P. ft. E. tion Date(I.kcal use only) 475 PT000479T EE0003804 12/31/1993 UPCF(12/99 revised)