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''• SILL i 1 i, •,. UNDERGR®UNI? STORAGE TANKS TANK PAGE 2 VI. PIPING CONSTRUCTION (Check all that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ® 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 458 ❑ I. PRESSURE ❑ 2. SUCTION [13. GRAVITY CONSTRUCTION [11. SINGLE WALL ❑ 3. LINED TRENCH ❑ 99. OTHER 460 ❑ 1. SINGLE WALL ❑ 95. UNKNOWN MANUFACTURER ® 2. DOUBLE WALL [195. UNKNOWN ❑ 2. DOUBLE WALL ❑ 99. OTHER MANUFACTURER AO �Strllth ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE w/100/ METHANOL [11. B [12. STAINLESS STEEL [17. GALVANIZED STEEL El Unknown F12. S El 3. PLASTIC COMPATIBLE W/ CONTENTS ❑ 99. Other [13. P ® 4. FIBERGLASS 11718. FLEXIBLE (HDPE) ❑ 4. FI ❑ 5. STEEL W/COATING [19. CATHODIC PROTECTION 464 ❑ 5. S VII. PIPING LEAK DETECTION (Check all that apply) UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST [13. ANNUAL INTEGRITY TEST (0.1GPM CONVENTIONAL SUCTION SYSTEMS ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUND PIPING): [17. SELF MONITORING GRAVITY FLOW EI 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 OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [1c. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION ® 12. ANNUAL INTEGRITY TEST (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 WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION [116. ANNUAL INTEGRITY TES ❑ 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT DATE INSTALLED 468 1998 I certify that the information prov' SIGNATURE OF O 4). R. LLRI NAME OF OWNE OP Chevron Products Co Permit Number (For local use only) 461 1 MANUFACTURER submitted to the local aaencv.) SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): El1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) [15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM El6. 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 EI9. 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 [I TANK Page 6 of 6 459 462 463 ARE STEEL ❑ 6. FRP COMPATIBLE Wnooi METHANOL TAINLESS STEEL ❑ 7. GALVANIZED STEEL LASTIC COMPATIBLE W/ CONTENTS ❑ 8. FLEXIBLE (HDPE) ❑ 99. OTHER BERGLASS [19. CATHODIC PROTECTION TEEL W/COATING EI 95. UNKNOWN abs A description of the monitoring program shall be b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST (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 WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LIN E LEAK DETECTOR (3.0 GPH TEST) VISUAL CHECK H LINER /MONITORIN T (0.1 GPH) I ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY ® 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [15. TRENC ® 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR El 6. NO DISPENSER + AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE MO -e and act a the best of my knowledge. COR DATE 8/271/02 rint) TITLE OF OWNER/OPERATOR n /D ERI Retail ESH S ecialist 73 Permit Approved (For local use only) Permit Expiration G NE Date (For total use only) 469 470 475 UPCF (1/99 revised) 178 Formerly SWRCB Form B