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Am lqw NIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 � '-VI.PIPING,CONSTRUCTON(Checka2matapplyt UNDERGROUND PIPING ""% ABOVEGROUND PIPING SYSTEM TYPE 1 PRESSURE ❑ 2.SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE - - ❑ 2.SUCTION ❑ 3. GRAVITY CONSTRUCTION/ 1❑ 11�SINGLE WALL 113. LINED TRENCH ❑99. OTHER 111. SINGLE WALL ❑95. UNMCAAM W MANUFACTURER 2, DOUBLE WALL 119S. UNKNONM 11 ❑ 2, DOUBIE WALL ❑B9.OTHER MANUFACTURER �NJ leAe� MANUFACTURER ❑ 1.BARE STEEL ❑ B.FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE WI 100%METHANOL MATERIALSAND ❑ 2,STAINLESS STEEL ❑ T.GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑T, GALVANIZED STEEL CORROSION PROTECTION ❑ 3.PLASTIC COMPATIBLE KITH CONTENTS ^^❑,95. UNKNOWN E WITH 3. PLASTIC COMPATIBLTH CONTENTS S.FLEKIBLE(HOPE) ❑99. OTHER 114. FIBERGLASS 13Ya'e B. FLEXIBLE(HOPE) 9.OTHER ❑ 4. FIBERGLASS ❑ 9.CATHODIC PROTECTION ❑ S. STEELWICOATING ❑ 9.CATHODIC PROTECTION ❑ S. STEEL WI COATING ❑95. UNKNOWN VIL PIPING LEAK DETECTION(CMck a9 that appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chaok 0Nat apply): - PRESSURIZEDPIPING(Chock aB lhatepply): 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TESTVATH AUTO PUMP SHUT OFF FOR ❑- 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TESTWITH 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 ❑ 2. MONTHLY 0.2 GPH TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) - - ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) 114, DAILY VISUAL CHECK - CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(CMck aB Nat appy: ❑ S.ONLY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. TRIENNIAL INTEGRITY TEST(0.1 CPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): - ❑ T.SELFMONITORING ❑ T. SELFMONITORING GRAVITY FLOW. GRAVITY FLOW(Check al that app K: ❑ 9.BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ S. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY MST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check a#Mat apply): PRESSURIZED PIPING(CMd as that appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (C_ick ona) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUALALARMS AND(Neck ona) 5,L,W�,�aa-AUTO PUMP SHUT OFF WHEN 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 SHUT OFF ❑ o. NO AUTO PUMP SHUT OFF 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ RESTRICTION it, gUTOMATIC LEAK DETECTOR ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12.ANNUAL INTEGRITY TEST IDA GPM) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITYSYSTEM: ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS - EMERGENCY GENERATORS ONLY(Cimaotm tat appy) EMERGENCY GENERATORS ONLY(Cna le ap thatePpyl ❑ 14.CONTINUOUS SUMP SENSOR NATHOUTAUTO PUMP SHUTOFF+AUDIBLE AND ❑ 14.CONTINUOUS SUMP SENSOR WITHOUTAUTO PUMP SHUT OFF-AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15 AUTOMATIC LINE LEAK DETECTOR RESTRICTION (3.0 GPM TEST) ❑ 1e.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 16.ANNUAL INTEGRITY TEST(0+1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VHLDISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE - ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2. ONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER MONITORING .CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS L1 5. NONE IX OWNER)OPERATDR SIGNATURE.. I oenly Nat Na Information pmerded herein is Wte anal evumle W the beet of my Moa age. SIGNATURE OF OVANERIOPERATOR DATE NAME OF OVMER/OPERATOR(pdri0 TITLE OF OVMEWOPERATOR Permit Numbes(Forlocal...oW PamNApproved(Fortcaltatoo y) PamH E1�'vaan DaM(Fakwro/aee ony) CUPAFORM(4/99) - Formerly SWRCB Form B