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D PROGRAM CONSOLIDATED F UIVDERGRO TANKS 6,1 (" 4 0? (p IJND STORAGE TANKS - Uk 2�� TANK PAGE 2 UNDERGRO VL PIPING CONSTRUCTION(Check,u chat a 1y) SYSTEM TYPE UND PIPING Pae of CONSTRUCTION/ ❑I PREASURE ❑2.SUCTION ABOVEGRO MANUFACTURER �I.SINGLE WALL ®7.GRAVITY 458. �1.PRESSURE UND PIPING ❑3.LINED TRENCH 13 g9 PT R ❑2.SUCTION DOUBLE WALL ❑95.UNKNOWN 46n ❑ I.SINGLE WALL 3'GRAVITY 459. MANUFACTURER ❑2.DO Ll 9s.UNKNOWN I.BARE STEEL I El 99 DOUBLE WALL 452. 6.FRP COMPATIBLE W/100%M��OL 461' MANUFACTURER .OTHER E32.STAINLESS STEEL 0 7,GALVANIZED STEEL El L BARE :I Cl 3.PLASTIC COMPATIBLE WITH CONTENTS ❑6.FRF COMPATIBLE W/100.METHANOLS ❑2.STAINLESS STEEL ®4.FIBERGLASS ❑g,FLEXIBLE(HDPE) ❑95 UNKNOWN EJ 3.PLASTIC COMPATIBLE W/CONTENTS ❑7 GALVANIZED STEEL ❑5.STEEL W/COATING ❑9.CATHODIC(HOPE) PROTECTION 99.OTHER ❑4,FIBERGLASS 118.FLEXIBLE(HDPE) ❑9.CATHODIC PROTECTION ❑99.OTHER VII.PIPING LEA °bp' �5.STEEL W/COATING UNDERGROUND PI DINGE�ION(Check all that apply)(A drscn tion oftke monilodn fJ 95.UNKNOWN SINGLE WALL P/PING SPmgnm shell be s,8mined to the l,cal,gency.) acs. PRESSURIZED PIPING nee. SINGLE WAL[,PIPING ABOVEGROUND PIPING (Check all that apply): ❑I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH g1I7p pip SHUT-OFF FOR LEAK,SYSTEM FAILURE, PRESSURIZED PIPING(Check all that a I 467' +AUDIBLE AND VISUAL ALARM$. AND SYSTEM DISCONNECTION )' ELECTRONIC LME LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,PND SYSTEM H AUTO PUMP 2. MONTHLY 0.2 GPH TEST +AUDIBLE AND VISUAL ALARM$ 03. ANNUAL INTEGRITY TESTGPH) 2. MONTHLY o.2 CPH TEST ECTION ❑3. ANNUAL INTEGRITY TEST(0.1 GPH) CONVENTIONAL SUCTION SYSTEMS ❑4. DAILY VISUAL CHECK ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIE CONVENTIONAL SUCTION SYSTEMS(Check all that a I INTEGRITY TEST(0.1 GPH) NNIAL PIPING SAPS SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): pp y) [15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [17. SELF MONITORING ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 139. BIENNIAL INTEGRITY TEST(0.1 GPH) ❑Z SELF MONITORING GRAVITY FLOW(Check all that apply): 118 DAILY VISUAL MONITORING SECONDARILY CONTAINED PIPING [39. BIENNIAL INTEGRITY TEST(0.1 GPH) PRESSURIZED PIPING(Check all that apply):I SECONDARILY CONTAINED PIPING 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE PRESSURIZED PIPING(Check all that apply): ALARMS AND(Check one) SUMP SENSOR WITH AUDIBLE AND VISUAL [I a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ALARMS AND(Check one) ❑b. AUTO PUMP SHUT OFF FOR ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS DISCONNECTION LEAKS SYSTEM FAILURE AND SYSTEM (]b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM Dc. NO AUTO PUMP SHUT OFF DISCONNECTION 0 11. AUTOMATIC LDIE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT (]c. NO AUTO PUMP SHUT OFF OFF OR RR37RX-DON ❑11. AUTOMATIC LEAK DETECTOR 012. nxrcuac f reJRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM [112. ANNUAL INTEGRITY TEST(0.I GPH) I3. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS SUCTION/GRAVITY SYSTEM /EMERGENCY GENERATORS ONLY(Check all that apply) ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO EMERGENCY GENERATORS ONLY(Check all that apply) AUDIBLE AND VISUAL ALARM��AUTO PUMP SHUT OFF ❑14. CONTINUOUS SUMP SENSOR WITFIOLIT AUTO PUMP SHUT OFF ❑I5. AUTOMATIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUDIBLE AND VISUAL ALARMS SHUT OFF OR RESTRICTION ( ) --AU2 FLOW ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑16. ANNUAL INTEGRITY TEST(O.I GPH) ❑17. DAILY VISUAL CHECK ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 468. ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INSTALLED 02. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS f]4 DAILY VISUAL CHECK 469. (]5. [13. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR TRENCH/LINER MONITORING DISPENSER A III IBLE AND VISUAL ALAILMS 6. NONE certify that the inform-ad IXOWERIO E ORSGNATURE ro eBinisTru a accu mkno SIGNATURE SIGN 0 RA 0 DATE:April 4,2007 470. E OF OWNEII TOR(print): AMY V1%te TITLE OF OWNER/OPERATOR: COIDpllanCe Manager 472' Permit Number(Agency use only) 473. Permit Approved By(Agency use only) 474. Pernfit Expiration Date(Agency use only) 475. UPCF hwfwre-b(1199)-3/4 www.unldocs.org Rev.02/16/00