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1 I -IED PROGRAM CONSOLIDATED FOR+ TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 Page_of VI.PIPING CONSTRUCTION(Check all that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 456 ❑1.PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 ❑95.UNKNOWN CONSTRUCTION I ❑1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 4W 1.SINGLE WALL�2.DOUBLE WALL ❑99.OTHER MANUFACTURER 02.DOUBLE WALL ❑95.UNKNOWN 463 MANUFACTURER EITVIrOn 461 MANUFACTURER_ [11.BARE STEEL ❑6.FRP COMPATIBLE will METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE W1100%METHANOL [12.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑UKNOWN [12. STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑99. OTHER ❑3. PLASTIC COMPATIBLE WI CONTENTS [18, CATHODIC PROTECTXIBLE(HI ❑ION9 OTHER ❑4. FIBERGLASS ®4.FIBERGLASS ®6.FLEXIBLE(HDPE) [195.UNKNOWN 465 ❑5.STEEL WICOATING ❑9.CATHODIC PROTECTION 464 ❑5. STEEL WICOATING VI 1.PIPING LEAK DETECTION(Cheek all that ap ly)(A description of the monitoring grogram ShaulABOVEGROUND PIPIING rcy UNDERGROUND PIPING SINGLE WALL PIPING 467 SINGLE WALL PIPING 466 PRESSURIZED PIPING(Chxk all InatapplY): PRESSURIZED PIPING(Check all that apply): 01. ELECTRONIC LINE LEAK DETECTOR 3.D GPH TEST WITH AUTO PUMP SHUT OFf FOR 01' ELECLEAK, AI URE,AND SYNIC LINE LEAK S EM SCONNECFEST TR 3.0 GPH I /IONITH+UAUDIBLETO PANDUVISUAL T OFF FO R LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECT-10N AUDIBLE ANDVISUAL ALARMS. ALARMS. 02. MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST ❑3. ANNUAL INTEGRITY TEST(0.1GPH) ❑3. ANNUAL INTEGRITY TEST(0.1GPH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) 05. DAILY VISUAL MONITORING OF PUMPING SYSTEM TRIENNIAL PIPING INTEGRITY []5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑7. SELFMONITORING GRAVITY FLOW that al [19. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW it all[3B. DAILY VISUAL MONITORING [19. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all Thal apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMSAND 10, CONTINUOUS TURBINE SUMP SENSOR WITHA(ChUDIBLE AND VISUAL ALARMS AND (Check one) ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS AUTO PUMP[01b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM b DISCONNECTION T OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION [jc. NO AUTO PUMP SHUT OFF [1c NOAUTO PUMP SHUT OFF ®11. AUTOMATIC LINE LEAK DETECTOR(10 GPH TEST)WITH FLOW SHUTOFF OR ❑11. AUTOMATIC LEAK DETECTOR RESTRICTION ®12. ANNUAL INTEGRITY TEST(0.1 GPH) [3 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONIGRAVITY SYSTEM 0 13. CONTINUONIGRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDI BLE AND VISUAL ALARMS ❑13. CONTINUOUS EMERUMP GENCY GENSOR AUDIBLE ONLY RMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND [114. V NTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ALARMS [115.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPI TEST) RESTRICTION El 16. ANNUAL INTEGRITY TEST(0.1 GPH) [116. ANNUAL INTEGRITY TEST(0.1 GPH) ❑17. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VII_DISPENSER CONTAINMENT DISPENSER ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK CONTAINMENT DATEINSTALLED 466 [12. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINERIMONITORING ®3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ [16.NONE 469 1998 AUDIBLE AND VISUAL ALARMS IX.OWNERIOPERATOR SIGNATURE I certify that the Information proNded herein is true and accurate to the best of my knpwletlge. DATE 470 SIGNATU OWNERIOP 0Z/2-1/OQ TITLE OF OWNERIOPERATOR 472 NAME OF OWNERIOPRATOR(print) Region Gasoline Environmental Com Mance Mana er Ian Moorhead Penni_Ewireticn Oats(For local useoniy) Pemtll Number(For local use only) 473 Permit Approvetl(For local use only) 475 Formerly SWRCB Form B UPCF (1/99 revised)