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a NIFIED PROGRAM CONSOLIDATED FO ®'7/ TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Checkalf that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE X 1. PRESSURE r 2. SUCTION h 3. GRAVITY h 1. PRESSURE F 2. SUCTION I 3. GRAVITY 459 CONSTRUCTION I' 1. SINGLE WALL F 3. LINED TRENCH F 99. OTHER I 1. SINGLE WALL IF 95. UNKNOWN 462 / X 2. DOUBLE WALL r 95. UNKNOWN F 2. DOUBLE WALL 1-99. OTHER MANUFACTURE /� �A R MANUFACTURER / M61 461 MANUFACTURER 463 r 1.BARE STEEL I 6. FRP COMPATIBLE W/100%METHANOL F 1 BARE STEEL 17 6. FRP COMPATIBLE W/100%METHANOL MATERIALS AND I'2, STAINLESS STEEL 1- 7. GALVANIZED STEEL I 2. STAINLESS STEEL F 7. GALVANIZED STEEL CORROSION PROTECTION F 3. PLASTIC COMPATIBLE WITH CONTENTS IF 95. UNKNOWN I 3. PLASTIC COMPATIBLE WITH CONTENTS F 8. FLEXIBLE(HDPE) F 99. OTHER X 4. FIBERGLASS r 8. FLEXIBLE(HDPE) F99. OTHER I 4. FIBERGLASS F 9. CATHODIC PROTECTION I 5. STEEL W/COATING F 9. CATHODIC PROTECTION 464 r 5. STEEL W/COATING r95. 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): I 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR I 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 SYSTEWFAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ALARMS I 2 MONTHLY 0.2 GPH TEST r 2. MONTHLY 0.2 GPH TEST I 3. ANNUAL INTEGRITY TEST(0.1 GPH) I' 3. ANNUAL INTEGRITY TEST(0.1 GPH) 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 I 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) I' 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): IF 7. SELF MONITORING r 7. SELF MONITORING GRAVITY FLOW. GRAVITY FLOW(Check all that apply) I 9. BIENNIAL INTEGRITY TEST(0.1 GPH) r 8. DAILY VISUAL MONITORING I� 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 I" a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS X b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION F b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION r c. NO AUTO PUMP SHUT OFF r c. NO AUTO PUMP SHUT OFF X 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR F 11. AUTOMATIC LEAK DETECTOR RESTRICTION I 12. ANNUAL INTEGRITY TEST(0.1 GPH) I 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: I 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS r 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check a//that apply) I 14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND I 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 r 16. ANNUAL INTEGRITY TEST(0.1 GPH) I 16. ANNUAL INTEGRITY TEST(0.1 GPH) T 17. DAILY VISUAL CHECK F 17. DAILY VISUAL CHECK VIII DISPENSER CONTAINMENT DISPENSER CONTAINMENT r 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 F 5. TRENCH LINER/MONITORING 2002 X 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS I' 6. NONE 469 IX.OWNERIOPERATOR RIGNATI IRE I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNF OWNER_/GPERATOR DATE 1/15/02 470 9 NAME OF OWNER/OPERAT R(print) 471 TITLE OF OWNER/OPERATOR 472 Bruce T. Marubashi for Equilon Enterprises LLC PERMIT ANALYST 925-766-3498 Permit Number(For local use only) 473 Permit Approved(For local use only) 474 1 Permit Expiration Date(For local use only) 475 jAk A6 6