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4IFIED PROGRAM CONSOLIDATED F TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 5 ' VI PIPING C �Rta�+ �bfJ{Glteckallth'etaFMyi ��' s UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE X 1. PRESSURE F 2. SUCTION F 3. GRAVITY r 1. PRESSURE F 2. SUCTION F 3. GRAVITY 459 CONSTRUCTION r 1. SINGLE WALL F 3. LINED TRENCH F 99. OTHER r 1. SINGLE WALL r 95. UNKNOWN 462 / X 2. DOUBLE WALL r 95. UNKNOWN r 2. DOUBLE WALL r 99. OTHER MANUFACTURE �� R MANUFACTURER 461 MANUFACTURER 463 F 1.BARE STEEL r 6. FRP COMPATIBLE W/100%METHANOL r 1. BARE STEEL F 6. FRP COMPATIBLE Wt 100%METHANOL MATERIALS AND F 2. STAINLESS STEEL r 7. GALVANIZED STEEL r 2. STAINLESS STEEL r 7. GALVANIZED STEEL CORROSION PROTECTION r 3. PLASTIC COMPATIBLE WITH CONTENTS r95. UNKNOWN F 3. PLASTIC COMPATIBLE WITH CONTENTS F 8. FLEXIBLE(HDPE) F 99. OTHER X 4. FIBERGLASS F 8. FLEXIBLE(HDPE) F 99. OTHER F 4. FIBERGLASS F 9. CATHODIC PROTECTION r 5. STEEL W/COATING F 9. CATHODIC PROTECTION 464 r 5. STEEL Wt COATING F95. UNKNOWN 465 �(!i 1�IR(NG LEAIf pEYEirT10N(GhaeGlt aCt(hat apph)( apse tplrne itt{ttie g(o lrfonn9 P+n9{am ahaG be sukrri(tf tt tt k�ce(,a ,•r _....� ..,,.,�._ t..,,�, ......... ._ ,..Pk. ., >-... UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING .467 PRESSURIZED PIPING(Check al/that apply): PRESSURIZED PIPING(Check all that apply): '- r 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR F 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 F 3. ANNUAL INTEGRITY TEST(0.1 GPH) r 3. ANNUAL INTEGRITY TEST(0.1 GPH) F 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that apply): F 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY F 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) r 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): F 7. SELF MONITORING F 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW(Check all that apply): F 9. BIENNIAL INTEGRITY TEST(0.1 GPH) F 8. DAILY VISUAL MONITORING r 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 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) FCheck one) a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS F a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS X b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM r b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION F 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 r 11. AUTOMATIC LEAK DETECTOR RESTRICTION F 12. ANNUAL INTEGRITY TEST(0.1 GPH) r 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: F 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS IF 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 F 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUAL ALARMS ALARMS r 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR r 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION r 16. ANNUAL INTEGRITY TEST(0.1 GPH) F 16. ANNUAL INTEGRITY TEST(0.1 GPH) F 17. DAILY VISUAL CHECK F 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT r 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE r 4. DAILY VISUAL CHECK DATE INSTALLED 468 r 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 F 6. NONE 469 IX OWNERIOEERATOR-SIGNATURE 1 certify that the information provided herein is true and accurate to the best of my knowledge. SIGNAT, F OWNER/ RATO - DATE 1/15/02 470 ) NAME OF OWNER/OPERATOR(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 I Permit Approved(For local use only) 474 ( Permit Expiration Date(For local use only) 475 6.