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LIOED ED PROGRAM CONSOLIDATED FORK TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION(Checkall mat appy) Page_of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 458 ❑1.PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 CONSTRUCTION/ ❑i.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 460 ❑1,SINGLE WALL ❑95.UNKNOWN 462 MANUFACTURER N2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461 MANUFACTURER 463 ❑1.BARE STEEL ❑6.FRP COMPATIBLE w1100% METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE wrom MErHANOL ❑2.STAINLESS STEEL [17,GALVANIZED STEEL ❑UKNOWN ❑2. STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/COfJTENTS ❑99. OTHER ❑3. PLASTIC COMPATIBLE WI CONTENTS ❑8.FLEXIBLE(HDPE) ❑99. OTHER [14.FIBERGLASS PLII(6.FLEXIBLE(HDPE) ❑4, FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL WICOATING ❑9.CATHODIC PROTECTION 464 ❑5. STEEL W/COATING ❑95.UNKNOWN 465 VII.PIPINGLEAK.DETECTION(Check a6 that apply)(A description of the monitoring program shall tie submitted to the local agency.I UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Cherk all that apply): ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION«AUDIBLE AND VISUAL LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. ALARMS. 02. MONTHLY 0.2 GPH TEST [3 2. MONTHLY 0.2 GPH TEST ❑3. ANNUAL INTEGRITY TEST(O.IGPH) 03. ANNUAL INTEGRITY TEST(O.iGPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check alt thatapply) ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY 05. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NOVALUES IN BELOW GROUNDPIPING): ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑7. SELFMONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW [17. SELF MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(check all that apply): ❑8. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check ane) (Check ane) V❑ . AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS It, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑c. NO AUTO PUMP SHUT OFF ❑c NO AUTO PUMP SHUT OFF 111. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR ❑11, AUTOMATIC LEAK DETECTOR RESTRICTION 412, ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTIONIGRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR*AUDIBLE AND VISUALALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND [3 14. CONTINUOUS SUMP SENSOR WITH UT AUTO PUMP SHUT OFF+AUDIBLE AND VISUALALARMS VISUALALARMS [315. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR [115, AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION [116. ANNUAL INTEGRITY TEST(0.1 GPH) ❑16, ANNUAL INTEGRITY TEST(0.1 GPH) [117 DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT''' DISPENSER �1 LOAT MECHANISM THAT SHUTS OFF SHEAR VALVE El 4.DAILY VISUAL CHECK CONTAINMENT DATEINSTALLED 468 � . C NTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS El 5.TRENCH LINER/MONITORING 14� 3. ONTINUOUB DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ 06.NONE 469 11 AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATU E I certify that the information provide erein is true and accurate to the beat of my knowledge. SIGNATURE OF OWNER/OPO DATE / lam' r� _ 470 NAME OF OWNER/OPRAT R(pnn) TITLE OF OW ER/OP RATOR 472 Bob DeNinno I I Environmental Manager Permit Number(For local use only) 473 Permit Approved(For local use only) Permit Expiration Date(For local use only) 475 UPCF(1/99 revised) Formerly SWRCB Form B