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*IED PROGRAM CONSOLIDATED FOR* <br /> TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI. PIPING CONSTRUCTION(Check ell that apply) Page-of <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 0 1.PRESSURE 12.SUCTION D 3.GRAVITY 458 [11.PRESSURE D 2. SUCTION 13.GRAVITY 459 <br /> CONSTRUCTION I rT 1.SINGLE WALL 13.LINED TRENCH 0 99,OTHER 460 1 1.SINGLE WALL 195.UNKNOWN 462 <br /> MANUFACTURER 3 2.DOUBLE WALL 195,UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER 461 MANUFACTURER 463 <br /> 11.BARE STEEL 0 6.FRP COMPATIBLE whom MBIHANOL 11.BARE STEEL D 6.FRP COMPATIBLE W1100%METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 1 UKNOWN 12. STAINLESS STEEL 17.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPATIBLEWI CQNTENTS D 99, OTHER 0 3. PLASTIC COMPATIBLE WI CONTENTS 0 B.FLEXIBLE(HDPE) [199, OTHER <br /> 14.FIBERGLASS FyyG 8.FLEXIBLE(HDPE) ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION <br /> 15.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 E]5 STEEL W/COATING 0 95.UNKNOWN 465 <br /> VII.PIPING:LEAK DETECTION(Check all that apply)(A description of the monitoring program shall be submitted to the local agency.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Checkall Ihalappy): PRESSURIZED PIPING(Check all that apply): <br /> ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR 11. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR <br /> LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL <br /> ALARMS. ALARMS. <br /> 02. MONTHLY 0.2 GPH TEST 12. MONTHLY 0.2 GPH TEST <br /> 13. ANNUAL INTEGRITY TEST(0.1GPH) 03. ANNUAL INTEGRITY TEST(0.1GPH) <br /> 14. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all matapply) <br /> 05. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY D5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 06. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> 17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 17. SELFMONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check a8 that apply): <br /> 08. DAILY VISUAL MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that appy) <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUALALARMS AND <br /> (Check one) (Checkone) <br /> Da. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Da AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 4b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 1 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> Dc. NO AUTO PUMP SHUT OFF 1c NO AUTO PUMP SHUT OFF <br /> 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR ❑11 AUTOMATIC LEAK DETECTOR <br /> RESTRICTION <br /> 012. ANNUAL INTEGRITY TEST(0.1 GPH) D 12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTIONIGRAVITY SYSTEM SUCTIONIGRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND 114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND <br /> VISUAL ALARMS VISUAL ALARMS <br /> 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR D 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> RESTRICTION <br /> [:116 ANNUAL INTEGRITY TEST(0.1 GPH) 0 16. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> D 17. DAILY VISUAL CHECK 017. DAILY VISUAL CHECK <br /> VIIL DISPENSER CONTAINMENT <br /> DISPENSER 01. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE D 4.DAILY VISUAL CHECK <br /> CONTAINMENT <br /> DAGTEINSTALLED 468 '�2. CONTINUOUS DISPENSER PAN SENSOR,AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER/MONITORING <br /> f 1� CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER, 0 6,NONE 465 <br /> AUDIBLE AND VISUAL ALARMS <br /> IX.OWNERIOPERATORSIGNATURE <br /> I dimity that the information provitl rein t accurate to thabest of my knowledge. <br /> SIGNATURE OF OWNE O DATE <br /> L470 <br /> `D� <br /> NAME OF OWNER/OPRA OR(print) TITLE OF OWNERIOPERATI 472 <br /> Bob DeNinno Environmental Manager <br /> Permit Number(For local use only) 473 Permit Approved(For(owl use only) Permit Expiration Date(For local use only) <br /> 475 <br /> UPCF (1/99 revised) Formerly SWRCB Form B <br />