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FROM JIM THORPE OIL, INC. FAX NO. : 209 368-185120 2002 02:59PM P5 Dec. Adv �y ClNIFIED PROGRAM CONSOLIDATED FORM TAiNKS UNDERGROUND STORAGE TANKS --TANK PAGE Z VL PIPINC CONSTRUCTION(check 411that ly) or_ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE .PRESSURE ❑2.SUCTION Cl 3.GRAVITY 418 (;(1.PRESSURE ❑2, SUCTION [13,GRAVITY 459 CONMIUMON ❑1.�;(LE WALL ❑3,LINED TRENCH ❑99.OTHER 4W ❑1.SINGLE WALL ❑95.UNKNOWN x62 a4ANUFACTUR&R DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461 MANUFACTURER 463 ❑1.BARE STEEL ❑6.FRP COMPATIDLE WA00% METHANOL Cl 1.BARE STEEL ❑6.FRP COMPATIBI.E W/100%METHANQL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑Unknown ❑2. STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑99. Other Cl 3, PLASTIC COMPATIBLE w/CONTENTS ❑S.FLEXIBLE(HOPE) ❑99. OTHER FIBERGLASS C S.FLEXIBLE(HDPE) ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION d 5.STEEL wrCOATING ❑9.CATHODIC PROTECTION 464 0 S. STEEL W/COATING ❑95.UNKNOWN 46S VIL PIPING LEAK DETECTION(Cheek ail that ly)(A dereriptionofthe monitoM% ,"submitted m the led ency.) UNDHRQROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply). PRESSURIZED PIPING(Check all that apply): ©I.ELECTRONIC-LINE LEAK DETECTOR 3.0 GPH TEST w=AUTO PUMP SHUT 0 1_ ELECTRONIC LANE LEAK DETECTOR 3.0 GPH TEST W=AUTO PUMP OFF FOR LEAD SYSTEM FAILURE.AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH TEST ' ©2. MONTHLY 02 GPH TEST [J 3.ANNUAL NTEGRITY TEST(0,IGPH) ❑3.ANNUAL INTEGRITY TEST(0.10PH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING ❑3. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM L%TEGRITY TEST(D.I GPH) SAFE SECTION SYSTEMS(NO VALUES IN BELOW GROUND PIPING): p 6. TRIEWIAL INTEGRITY TEST(O,1 GPH) Q'7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELO*GROUND PIPING): GRAVITY FLOW [17. SELF MONITORING [19.BIEN 1IAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all tint vpiy)' ❑$. DAILY VISUAL MONITORING [19, BIENNIAL INTEGRITY TEST(0.1 GPH) SECQNDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Cb�k ul thu apply). PRESSURIZED PIPING(Check an that apply?. 10. CONTLNUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL W. CONTINUOUS TURAINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALA$54t AND(Cheek o,rc) ALARMS AND(Check one) WL AUTO PUMP SHUT OFF W HSN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b- A(,70 PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑c. NO AUTO PUMP SHUT OFF ❑e NO AUTO PUMP SHUT OFF I*t. AUTOMATIC LINE LEAK DETECTOR(30 GPH TEST)YLn FLOW SHUT Q 11. AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRITY TEST(O,I GPM) S�U,CT1ON(GRAVITY SYSTEM SUCTION(ORAVITY SYSTEM **','CONTINUOUS SUMP SENSOR*AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Cheek=P tam apply) EMERGYNCY GENERATORS ONLY(Check all that apply) !4. CONTINUQUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• ❑14. CONTINUOUS SUbIP SENSOR wuHOUT AUTO PUMP SHUT OFF` r+D[eLE AND VISUAL ALARMS AUDIBLE ADND VISUAL ALARMS 5. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)W11HO FLOW (:]15, AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION ❑16.&NNUAL INTEORITY 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 W4.DAILY VISUAL CHECK DATE INSTALLED 4" ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS []S.TRENCH LINER/MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6.NONE 469 DISPENSER*AUDIBLE AND VISUAL.ALARMS IAC.OWNERIOPERATOR SIGNATURE 1 ceniry Ebtt Etta inklmiIan provAg herein ix d4% u_IV as • 'IGNATI ERATO / ATE 4,0 NA O O t) 411 WA OFOWN P£ TO4111111111. 472 • / PcEm4 Number(F.,bn1 mte only) 1 473 6 Pertoit Approved(Fot l=i Use otuy) 474 Prtttdt Expiration Date(For k>al ure only) 41 UPCF(12/99 revised) 0 Formerly SWRCB Form 8