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FROM JIM THORPE OIL, INC. • FAX NO. : 209 368-1851 Dec. 20 2002 03:00PM P6 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all that zuto Pads-or- Wi D£RGROLND PIING ABOVEGROUND PIING SYSTEM TYPE .PRESSURE ❑2.SUCTION ❑3.GRAVTTY 458 [J 1.PRESSURE ❑2. SUCTION ❑3•CPAV1 Y 459 CONSTRUCTION ❑1.SLE FALL Q 3.LINED TR NCIi M 49.OTHER 460 ❑1.SINGLE WALL [395.UNILNOWN 462 MANUFACTL ME C16119ILE WALL ❑95.UNKNOWN • ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461 MANUFACTURER 463 ❑I.BARE STEEL ❑6.FRP COMPATIBLE -/tt>ai METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE W1100%MfTHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑Unknown ❑1, STAINLESS STEEL ❑7.GALvA,NIZED STEEL ❑3.P TIC COMPATIBLE W1 CONTENTS ❑99. Other ❑3. PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPE) ❑99. OTHER ,FIBERGLASS [:18.FLEXIBLE(TiDPE) ❑4. FIBERGLASS Q 9.CATHODIC PROTECTION ❑ S.STEEL W/COATING ❑%CATHODIC PROTECTION 464 ❑5. STEEL W/COATING ❑95.UNKNOWN 46s VII.PIPING LEAK DETECTION(Cheek all that apply)(A leeeription olthe monitor am slow be submined to the brat a T UNDERGROUND PWING ABOVEGROUND PIPING SINGLE WALL PIPING 466 MGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply); PRESSURIZED PIPING(cheek oil out vpM: ❑I-ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST M AUTO PUMP SMJT p Y-Ft-�i teuNIL itNc LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK SYSTFM FAILURE,AND SYSTEM DISCONNECTION+ SMUT OFF FOR LEAK.SYSTEM FAILURE,AND SYS'T'EM DISCONNECTION+ AUDIBLE AND VISUAI-6.LARMS. AUDIBLE AND VISUAL ALARMS. ❑2-MONTHLY 0,2 GPH TEST' ❑2. MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.10PH) q 3.ANNUAL INTEGRITY TEST(O.IGPH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chm%Ad Thor 4PPtY) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING ❑5. DAILY VISUAL MONITORING OF PIPING AND PUMPL40 SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROLNI)PIPING): ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELO*GROUND PIPING); GRAVITY FLOW ❑7. SELF MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(cuo an utat applo ❑8. DAILY VISUAL MONITORING ❑9. 13MINNIAL INTEGRITY TEST(0.T GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10. CONTIVUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIULt AND VISUAL ALA AND(Check one) ALARMS AND(Cheep obe) a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑st AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FANLURE AND SYSTEM ❑la AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Cc. NO AUTO PUMP SHUT OFF ©c NO AUTO PUMP SHUT OFF mR*r'AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)wJTH FLOW SHUT ❑11 AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION;GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS F-MERGENCY GENERATORS ONLY(check ad that apply) EMERGENCY OF-4ERATORS ONLY(Cheek all tho-ly) la- CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' ❑Is. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF UDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS VIS. AUTOMATIC LIVE LEAK DETCCTOA(3.0 GPH TEST)WITHQFLOW 015. AUTOMATIC LINE LEAK DETECTOR(3.o GPH TrST) SHUT OFF OR RESTRICTION C 16.ANNUAL INTEGRITY TEST(0.1 GPH) ©16.ANNUAL INTEGRITY TEST(0.1 GPH) ©17. DAILY VISUAL CHECK C1 17, DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 3r4.DAILY VISUAL CHECK DATE TNSTALLED 469 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR 18M AUTO SHUT OFF FOR ❑6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNERIOPERATOR SIGNATURE I ceraty That rhe info mn prov' hstcin h, dt� vrak • IGNATUR ERATO I ATE 470 NA0 OtPETO 72 1,Y ; Pnmo Number(FA,brat use only) V 473 9 Permit Approved(For local uie OdIY) 474 Permit Expiration Date(For local ase only) 475 UPCF(12/99 revised) 40 FolTtl+alrfy SWRCB Forty:11