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b-RTrIED PROGRAM CONSOLIDATED FORlr' TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION(Check a#M%lappW UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ t PRESSURE =11E 2. U TIO 1 ❑ 3. GRAVITY ❑ 1, PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ 1. SINGLE WALL yy❑la�3. LINED TRENCH [IN. OTHER ❑ 1. SINGLE WALL _ a UNKNOWNMANUFACTURER 112, DOUBLE WALL %ML UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ 8. FRP COMPATIBLE WI 100%METHANOL ❑ 1. BARE STEEL ❑ B. FRP COMPATIBLE Wl 100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ T.GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS �5. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXISLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE(HDPE) 110 OTHER ❑ 4. FIBERGLASS ❑ B. CATHODIC PROTECTION ❑ 5. STEELW/COATING ❑ 8. CATHODIC PROTECTION ❑ 5. STEELW/COATING 0 9. UNKNOWN W.PIPING LEAK DETECTION(Cheek all metappy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check ell Met appfy): PRESSURIZED PIPING(CMM ak Net apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION I AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION rAMBLE AND VISUAL ALARMS ALARMS El2 MONTHLY 92 GPM TEST ❑ 2. MONTHLY D2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3.ANNUAL INTEGRITY TEST IDA GPH) ❑ 4, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check 0Maf appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) ❑ S. TRIENNIAL INTEGRITY TEST DA GPHI SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' ❑ T. SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(CMMaB Met III ❑ -9 BIENNIAL INTEGRITY TEST(01 GPH) ❑ 8. DAILY VISUAL MONITORING ❑ 8. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(CMM ell II PRESSURIZED PIPING(Check till fNf apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMSAND CMM l 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(chert Nu) me ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ 0. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ 8, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ C. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST IDA GPH) SUCTIONIGRAVITY SYSTEM'. SUCTION/GRAVITYSYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR i AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(CMMW that appy) EMERGENCY GENERATORS ONLY(Check 0Mid eppM ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF-AUMBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF v.AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION ❑ 18. ANNUAL INTEGRITY TEST(DA GPH) ❑ IS.ANNUAL INTEGRITY TEST IDA GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSSITIALLLED({T�y� ❑ 2. CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER I MONITORING uA1C..�V WYI ❑ 3. CONTINUOUS DISPENSER PAN SENSOR NTH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS NONE IX OWNER/OPERATOR SIGNATURE I u y But Me Infofmaam plovMe l haMn is mu art timuab W IM Bas,of my Nnp .d, SIGNATURE OF OWNERK)PERATOR DATE NAME OF OWNER/OPERATOR Me" TITLE OF OWNERrOPERATOR PMmh NumWIFurm use pNy) PamYl Appmvb(Ftincceluse Dully) Pa et Expktiem OW(FmkKN us anM is-q -aq� CUPAFORM(4/99) Formerly SWRCB Form B