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UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANK VL PIPING CONSTRUCTION Check all that a 1 UNDLROROUND PIPING', Page of SYS"ITM TYPE , ABOVEGROUND PIPING ® 1. PRESSURE ❑ _ SUCTION ❑ 3. GRAVITY 458 ❑ L PRESSURE ❑ 2. SUCTION CONsrRUC91oN ❑ t. SINGLE WALT. ❑ 3. L1N[iD "TRENCH ❑ 3. GRAVITY 459 ❑ 99- OTHER 460 ❑ 1. SINGLE WALL ❑ 95- UNKNOWN 462 MANUFACTURER ® 2. DOUBLE WALL 1195. UNKNOWN ❑ 2. DOUBLE WALL c MANUFACTURER TELEFLEX ❑ 9) OTHER HLR 461 MANUFACTURER ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE w/100% ME111ANOL ❑ 1. BARE STEEL 463 ❑ 2. STAINLESS STTEL ❑ 6. FRP COMPA'T'IBLE W/100% METHANOL ❑ 7. GALVANIZED STEEL I ❑ Unknown ❑ 2. STAINLESS STEEL ❑ Z GALVANIZED ST'E'EL ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS ❑ 99. Other ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS I ® 4. FIBERGLASS ❑ 8.1,LEXIBLE (HDPE) ❑ 8. ATH (HDI F) ❑ 99. OTHER❑ 4. h[I3ERGLASS ❑ 9. CCATHODDIC P120'TIiCTION ❑ 5 STEEL. W/COATING ❑ 9. CATHODIC PROTECTION 464 ❑ 5 S"PEEL W/GOA"PING ❑ 95. UNKNOWN 465 VII. PIPING LEAK DETECTION (Check all that apply) (A description of the monitoring program shall be submitted to the local aeenev ) UNJAIROROI TNT) PIPltrll SINGLE, WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ❑ 1. ELECTRONIC: LINE LEAK DETTCT'OR 3.0 GPH TEST WITH AUTO PUMI> SHU'1' OFF FOR LEAK, SYSTEM FAILURE, AN) SYSTEM DISCONNECTION AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3- ANNUAL INTEGRI'TY TEST (0.1 GPI 1) CONVENTIONAL SUCTION SYSTEMS ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +'TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): ❑ T SELF MONITORING GRAVITY FLOW ❑ 9. BIENNIAL IN'T'E'GRIT'Y TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTTNUOLIS TURBINE SUMP SENSOR WI'T'H AUDIBLE AND VISUAL ALARMS AND (Check one) 13a, AIfTO PLUMP SITLI'T OFF WIZEN A LEAK OCCURS [3b, AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNEC'T'ION ®c. NO AUTO PUMP SHUT OFF ®I L AUT'OMAT'IC; LINE LEAK DETECTOR (3.0 GPII TEST) WITH FLOW SHUT OFF OR RESTRICTION ® 12. ANNUAL INI'L'GRITY TESL (0.1 GPH) SUCTION/GRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE' AND VISUAL, ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOIUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETEC'T'OR (3.0 GPI -I TEST) _W_1TT{OLpr FLOW SHUT OFF OR RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST (0.I GPH) ❑ 17. DAILY VISUAL CHECK SINGLE WALL. PIPING 467 PRESSURIZED PIPING (Check all that apply) ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYS'T'EM DISCONNECTION + AUDIBLE AND VISUAL. ALARMS. ❑ 2. MONTHLY 0.2 GPII TEST ❑ 3. ANNUAL INT'EGRITY'TEST (0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION S YSTEMS (Check all that apply) ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING GRAVITY FLOW (Check all that apply): ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b AUTO PUMP SHUT OFFFOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c NO AUTO PUMP SHUT OFF ❑ 11, AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY I -EST (0.1 GPH) SUCTION/GRAVITY SYSTE.M ❑ 13. CONTINUOUS SUMP SENSOR I AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINK LEAK DET'ECT'OR (3.0 GPI I T'EST) ❑ 16. ANNUAL, INTEGRITY TEST (0.1 GPII) ❑ 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ® L FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INST'ALLF.D 468 ❑ 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLI AND VISUAL ALARMS ❑ 4 DAILY VISUAL CHECK 1995 ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUT) SHUT OFF FOR ❑ 5. 'TRENCH LINER / MONITORING + AUDIBLE AND VISUAL ALARMS ❑ 6. NONE IX. OWNER/OPERATOR SIGNATURE I certify that dte information provided herein 6s We aiid accurate to the best of my knowledge. SIGNAT�JI2E OF' O,WNEIjLQPERATOR----------------- E OF OWNER/C>1'RATOR (print) SANDY EDWARDS Nmnber (For local use only) UPCF (1/99 revised) 473 Permit Approved (For local use OF OWNER/OPERA'TOR 469 mL� � � A 472 For loje l use only) 47 Formerly SWRCB Form B