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FIED PROGRAM CONSOLIDATED Fe <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANK <br /> VI.PIPING CONSTRUCTION(Check e11 that a 1) <br /> UNDERGROUND PIPING Poge `of <br /> SYSTEM TYPE PRESSABOVEGROUND PIPING <br /> URE <br /> ❑2.SUCTION ❑3.GRAVITY 458 ❑1.PRESSURE ❑2. SUCTION <br /> CONSTRUCTION ❑1.SINGLE WALL ❑3.LINED TRENC}I ❑99.OTHER 460 ❑3.GRAVITY 459 <br /> MANUFACTURERZ{2.DOUBLE WALL ❑ 1.SINGLE WALL ❑95.UNKNOWN 462 <br /> /�* ❑95.UNKNOWN ❑2.DOUBLE WALL. <br /> 13 99.OTHER <br /> MANUFACTURER <br /> N - C' LL• 461 MANUFACTURER <br /> ❑ 1.BARE STEEL ❑6.FRP COMPATIBLE w/100' METHANOL 463 <br /> ❑1.BARE STEEL ❑6.FRP COMPATIBLE Wn00%METHANOL <br /> ❑2.STAINLESS STFF.1, ❑7.GAI,VANL7,F,D STEEL. ❑Unknown <br /> ❑2. STAINI..FSS STEEL ❑7.GALVANIZED STEEL, <br /> ❑3.PLAS'11C COMPATIBLE W/CONTENTS ❑99. OWef <br /> [13. I LAS'l'IC COMI A'I'I11LC W/CONTENTS ❑8.FLEXIBLE(HDPE) ❑99. OTHER <br /> 4.FIBERGLASS ❑8.FLEXIBLE(IIDI'li) <br /> ❑4. FIBERGLASS [J 9.CATHODIC PROTECTION <br /> STEEL W/COATING ❑9.CATHODIC PROTECTION 464 O <br /> ❑S. STEEL W/CATING ❑95.UNKNOWN <br /> VII.PIPING LEAK DETECTION(Check all dtat I A descri tion of the nnnitorin ro rmn shall he subu9tted to the local agency.) <br /> 465 <br /> UNDERGROUND PIPING y) <br /> SINGLE WALL PIPING ABOVEGROUND PIPING <br /> 466 SINGLE WALL PIPING <br /> PRESSURIZED PIPING(Check all that apply): 467 <br /> ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT PRI SSURI"l,ED PIPING(Check.11 that apply): <br /> OFF FOR LEAK,SYS'T'EM FAILURE,AND SYSTEM DISCONNECTION+ ❑1• ELECTRONIC LINE LEAK DE'T'ECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> AUDIBLE AND VISUAL ALARMS. SHUT OTT'FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> ❑ <br /> 2.MONTHLY 0.2 GPH TEST <br /> AUDIBLE AND VISUAL ALARMS.❑ <br /> ❑3.ANNUAL INTEGRITY TEST(U.1GPH) 2. MONTHLY 0.2 GPH TEST <br /> ❑3.ANNUAL INTEGRITY TEST(0.IGP11) <br /> CONVENTIONAL SUCTION SYSTEMS 134. DAILY VISUAL CHECK <br /> ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> INTEGRITY TEST(0.1 GPH) [15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): <br /> ❑6. TRIENNIAL INTEGRITY'PEST(0.1 GPIT) <br /> ❑7.SELF MONITORING <br /> GRAVITY FLOW SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> ❑9.BIENNIAL INTEGRITY TEST(U.1 GFH) ❑7. SELF MONITORING <br /> GRAVITY FLOW(Check all that apply); <br /> ❑8. DAILY VISUAL MONITORING <br /> SECONDARILY CONTAINED PIPING El9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> PRESSURIZED PIPING(Check all that apply): SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that a <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL. apply): <br /> ALARMS AND(Clock oto) 10. CONTINUOUS TURBINE St IMP SENSOR-WILT!AUDIBLE AND VISUAL <br /> ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ALARMS AND(t'hrck,vo) <br /> )b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑`t AUTO PUMP SIIU'1'019-'WIIEN A LEAK OCCURS <br /> DISCONNECTION ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> ❑c. NO AUTO PUMP SHUT OFF DISCONNECTION <br /> �I L AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT ❑c NO AUTO PUMP SHUTOFF <br /> OFF OR RESTRICTION 1111- AUTOMATIC LEAK DETECTOR <br /> ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑12. ANNUAL INTEGRITY TEST(0.1 GFH) <br /> SUCTION/GRAVITY SYSTEM <br /> SUCTION/GRAVITY SYSTEM <br /> ❑13. CON'T'INUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) <br /> T AUTO PUMP SHUT OFF* EMERGENCY GENERATORS ONLY(Check all that apply)❑14. CONTINUOUS SUMP SENSOR W I HO <br /> AUDIBLE AND VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPII TEST)WITHOUT FLOW AUDIBLE AND VISUAL ALARMS <br /> SHUT OFF OR RESTRICTION ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ 16.ANNUAL INTEGRITY TEST(0.1 GFH) <br /> ❑17. DAILY VISUAL CHECK <br /> ❑17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE <br /> DATE INSTALLED46g ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑4.DAILY VISUAL CHECK ' <br /> ❑5'TRENCH LINER <br /> [33.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR /MONITORING <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6.NONE 469 <br /> IX.OWNER/OPERATOR SIGNATURE <br /> ]certify that the infommtion provided hereat is true and accurate to the hest of my knowledge. <br /> S1GNA EOFjpWNE OPE R <br /> DATE �J <br /> ,✓ ` Com(. et U -/ -V 470 <br /> N OFOWNER/O OR(print) <br /> TITLE OF OWNER/OPERATOR 472 <br /> nf e l-1 IV yr <br /> I <br /> UPCF(1/99 revised) 175 <br /> Formerly SWRCB Form B <br />