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IED PROGRAM CONSOLIDATED F OR9'"� TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 W.PIPING CONSTRUCTION(Check a06reapoW „ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE . SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ 1. SINGLE WALL ❑ 3. UNEOTRENCH ❑99. OTHER ❑ 1. SINGLE WALL 13 B5. UNKNOWN MANUFACTURER ❑ 2, DOUBLE WALL CalItc Ate. UNKNOWN El 2. DOUBLEWALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ 6. FRP COMPATIBLE W/100%METHANOL ❑ 1. &IRE STEEL ❑ 6. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE MATH CONTENTS . UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 6. FLEXIBLE(HDPE) 099. OTHER ❑ 4. FIBERGLASS ❑ S. FLEMBLE(HOPE) 09. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑95. UNKNOWN VII.PIPING LEAK DETECTION(Clrock W Ma/apply) UNDERGROUND PIPING ABOVEGROUND PIPING NGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(CM k 0 that apply).' PRESSURIZED PIPING(Check 0 Mat apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3D GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST NTH 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 11 2. MONTHLY 0.2 GPM TEST 113. MONTHLY 0.2 GPT TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check 0 Mat appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(D.1 GPM) ❑ B. TRIENNIAL INTEGRITYTEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) ❑ 7, SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW. GRAVITY FLOW(Check aM Mat appy): ❑ 99.�BIENNIAL �INTEGRITY MST(0.1 GPM) 13B. DAILY VISUAL MONITORING D9�/ll/�(� ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Cock all that appy): PRESSURIZED PIPING(Check aN Mat appy): 10. CONTINUOUS TURBINE SUMP SENSOR W TH AUDIBLE AND VISUAL ALARMS AND (Chat..I 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(p e k orr) ❑ a. AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ b, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SMUT OFF ❑ c NOAUTOPUMPSHUTOFF ❑ 11. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY TEST(DA GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONIGRAVITY SYSTEM: SUCTIONIGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR I AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR I AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chock aA that appy) EMERGENCY GENERATORS ONLY(Check aM Mat appy) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15.AUTOMATIC UNE LEAK DETECTOR(3D GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 15.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 16. ANNUAL INTEGRITY MST(0 1 GPH) ❑ IT. DAILYVISUALCHECK ❑ 17. DAILY VISUAL CHECK VOL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK GAMIN TA 0 ❑ 2. CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER I MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑ 8. NONE IX OWNERADPERATOR SIGNATURE I ca VY that aR pmvkee herein is hue aIM Rmni a to 6M heal olmy ktm o d,. SIGNATURE OF OWNERIOPERATOR DATE NAME OF OW9NERIOPERATOR(php TITLE OF OWNERIOPERATOR Pam�ll Number(Fwbul uas orMy) Parmb Appm (Fortucalusemly) PemW EkprWon DN(Fwbcal use oMy 0 CUPAFORM(4/99) Formerly SWRCB Form B