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NIFIED PROGRAM CONSOLIDATED FO ::::7 UNDERGROUND ST TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(check all that apply) UNDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE X 1. PRESSURE T 2. SUCTION r 3. GRAVITY r 1. PRESSURE r 2. SUCTION r 3. GRAVITY 459 CONSTRUCTION r 1. SINGLE WALL r 3. LINED TRENCH r99. OTHER r 1. SINGLE WALL r 95. UNKNOWN 462 / X 2. DOUBLE WALL r95. UNKNOWN r 2. DOUBLE WALL r 99. OTHER MANUFACTURE NNn R MANUFACTURER ,Y,L. PJ 461 MANUFACTURER 463 I' 1.BARE STEEL I 6. FRP COMPATIBLE W/100%METHANOL r 1. BARE STEEL I-6. FRP COMPATIBLE W/100%METHANOL MATERIALS AND F 2. STAINLESS STEEL I' 7. GALVANIZED STEEL F 2. STAINLESS STEEL I' 7. GALVANIZED STEEL CORROSION PROTECTION r 3. PLASTIC COMPATIBLE WITH CONTENTS I 95, UNKNOWN F 3, PLASTIC COMPATIBLE WITH CONTENTS r 8. FLEXIBLE(HDPE) r99. OTHER X 4. FIBERGLASS F 8. FLEXIBLE(HDPE) r99. OTHER I' 4. FIBERGLASS I'9. CATHODIC PROTECTION I 5. STEEL W/COATING I, 9. CATHODIC PROTECTION 464 I' 5. STEEL W/COATING r 95. UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that apply)(A description of the monitoring 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): r 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR" r 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ALARMS r 2. MONTHLY 0.2 GPH TEST r 2. MONTHLY 0.2 GPH TEST r 3. ANNUAL INTEGRITY TEST(O.t GPH) I 3. ANNUAL INTEGRITY TEST(0.1 GPH) r 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that apply): I 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY r 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) F 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): r 7. SELF MONITORING T 7. SELF MONITORING GRAVITY FLOW: 9. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): I` IF 8. DAILY VISUAL MONITORING F 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 ALARMS AND (Check one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) F a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS r a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS X b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION r b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION IF c. NO AUTO PUMP SHUT OFF IF c. NO AUTO PUMP SHUT OFF X 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR I 11. AUTOMATIC LEAK DETECTOR RESTRICTION I 12. ANNUAL INTEGRITY TEST(0,1 GPH) T 12, ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: r 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS T 13, CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) r 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND r 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUAL ALARMS ALARMS I 15, AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR I 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION I 16. ANNUAL INTEGRITY TEST(0.1 GPH) r 16, ANNUAL INTEGRITY TEST(0.1 GPH) I IT DAILY VISUAL CHECK F 17. DAILY VISUAL CHECK Vlll.DISPENSER CONTAINMENT DISPENSER CONTAINMENT F 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE F 4. DAILY VISUAL CHECK DATE INSTALLED 468 F 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS IF 5. TRENCH LINER/MONITORING 2002 X 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS r 6. NONE 469 'X.OWNERIOPERAIDR SIGNATI IRE I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATVRk F OVUNERATO ) DATE 1�15/02 470 Ar- ZI NAME OF OWNER/OPERATOR(print) 471 TITLE OF OWNER/OPERATOR 472 Bruce T. Marubashi for Equilon Enterprises LLC PERMIT ANALYST 925-766-3498 7Permit Number(For local use only) 473 Permit Approved(For local use only) 474 Permit Expiration Date(For local use only) 475 6