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IED PROGRAM CONSOLIDATED FOR TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 Page or VI.PIPING CONSTRUCTION(Check all that apply) UNDERGROUND PIPING ABOVEGROUND PIPING 459 SYSTEM TYPE N 1.PRESSURE ❑2.SUCT460 ION ❑3.GRAVITY 460 ❑1.PRESSURE El 2. SUCTION 1.SINGE WALL ❑95.UNKNOWN[13.GRAVITY 462 CONSTRUCTION I [11.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER ❑ ❑2.DOUBLE WALL [199,OTHER MANUFACTURER N 2.DOUBLE WALL ❑95.UNKNOWN 463 461 MANUFACTURER_ MANUFACTURER Environ ❑1.BARE STEEL ❑6.FRP COMPATIBLE w/1DO% METHANOL ❑1.BARE STEEL FRP COMPATIBLE WIi00%METHANOL ❑6. ❑ ❑2. STAINLESS STEEL Cl 7.GALVANIZED STEEL 2.STAINLESS STEEL ❑7.GALVANIZED STEEL [IUKNOWN ❑3.PLASTIC COMPATIBLE W/CONTENTS [199. OTHER ❑3. PLASTIC COMPATIBLE WI CONTENTS[14. FIBERGLASS O 9 FLEXIBLE (ODIC OPE) 0 99 OTHER ®4.FIBERGLASS N B.FLEXIBLE(HDPE) 465 ❑5.STEEL WICOATING [19.CATHODIC PROTECTION 464 [15. STEEL W/COATING ❑95.UNKNOWN VII:PIPING:LEAK DETECTION(Check an that apply)(A deacnpticn of the monitoring 1program shall BOVEGROUNesubmitted to the PIPING�) A UNDERGROUND PIPING SINGLE WALL PIPING q87 SINGLE WALL PIPING ass PRESSURIZED PIPING(Check all that applyl: PRESSURIZED PIPING(Check all that apply): ST WITH❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR 1. ELECTRONC LINE LEAK DETECTOR 3.0 GPI-1 TE - LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTIONAUAUDIBLEIAND VISUAL TO PUMP SHUT OFF OR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE ANDVISUAL ALARMS. ALARMS. ❑2, MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST [13. ANNUAL INTEGRITY TEST(O.1GPH) ❑3. ANNUAL INTEGRITY TEST(0.1GPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY [35. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) [16, TRIENNIAL INTEGRITY TEST(O.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑7. SELF MONITORING ❑7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check all that apply): 09. BIENNIAL INTEGRITY TEST(0.1 GPH) [38. DAILY VISUAL MONITORING [39. 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 SENSORWITH AUDIBLE ANDVISUAL ALARMS AND 10, CNTIoN'UOUS TURBINE SUMP SENSOR WITH AUDIBLE ANDVISUALALARMS AND (Check one) ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 01b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Oc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF Nit. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR ❑11. AUTOMATIC LEAK DETECTOR RESTRICTION W. ANNUAL INTEGRITY TEST(0.11 GPH) N 12, ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONIGRAVITY SYSTEM 0 13. CONTINUONIGRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE ANDVISUAL ALARMS ❑13. CONTINUOUS EMERUMP GENCY GENSOR AUDIBLE ONLY(Check RMS EMERGENCY GENERATORS ONLY(Check an that apply) EMERGENCY GENERATORS ONLY(Check all that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND El 14. V NTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND AALARVISUALALARMS [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHO T FLOW SHUT OFF OR [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) [I is. ANNUAL INTEGRITY TEST(0.1 GPH) ❑17. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK - VIII.DISPENSER"UN TAINMENT DISPENSER ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK CONTAINMENT DATEINSTALLED 456 ❑2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [3 5.TRENCH LINER/MONITORING N3. CONTINUOUS DISPENSERPAN SENSORWITHAUTO SHUTOFF FORDISPENSER+ [16.NONE 469 1998 AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERA I OR SIGNATURE 1 certify that the informatlon provided herein is true and accurate to the best of my knowledge. 470 SIGNATURE OF OW NERIOPERATOR DATE 0211 ti O? 472 NAME OF OWNER/OPRATOR(print) TITLE OF OWNER/OPERATOR Ian Moorhead Region Gasoline Environmental Com liance Mana er Permit Expiration Date(For local use only) Perot Nufter(For local use only) 473 Permit Approved(For local use only) 475 Formerly SWRCB Form B UPCF (1/99 revised)