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MFIED PROGRAM CONSOLIDATED FOk <br /> TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Check an that apply) Page-of <br /> ERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE O;PRESS;URE 0 2.SUCTION 0 3.GRAVITY 458 01.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 <br /> CONSTRUCTION] 0 1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 0 1.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER 02.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER EDVIFOn 461 MANUFACTURER 468 <br /> 01.BARE STEEL 0 6.FRP COMPATIBLE w1IDi METHANOL 0 1.BARE STEEL ❑6.FRP COMPATIBLE W/700%METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 03.PLASTIC COMPATIBLE W1 CONTENTS 099. OTHER 03. PLASTIC COMPATIBLE WI CONTENTS 08.FLEXIBLE(HOPE) 099. OTHER <br /> 0 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) 0 4. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 1 0 5. STEEL W/COATING 0 95.UNKNOWN 465 <br /> VII.PIPING LEAK.DETECTION(Check all that apply)(A do ption of the monitoring program shin be submitted to the local agency.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check al Matappty): PRESSURIZED PIPING(Check all thud apply): <br /> 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESTVp ITH AUTO PUMP SHUT OFF FOR 01. 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 /> [12. MONTHLY 0.2 GPH TEST 02. MONTHLY 0.2 GPH TEST <br /> 03. ANNUAL INTEGRITY TEST(0.1GPH) 03. ANNUAL INTEGRITY TEST(O.1GPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check ae that apply) <br /> 05. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY 05. 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 /> 0 7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW [17. SELF MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(chess,all that appry): <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 apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSORWITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br /> (Chak ore) (Check erre) <br /> 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Oa AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> Ob. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM Ob AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> Oc. NOAUTO PUMP SHUT OFF Dc NO AUTO PUMP SHUT OFF <br /> ®11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR 011 AUTOMATIC LEAK DETECTOR <br /> RESTRICTION <br /> ®12. ANNUAL INTEGRITY TEST(0.1 GPM) 012. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY 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 /> 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND <br /> VISUALALARMS VISUAL ALARMS <br /> [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOU FLOW SHUT OFF OR 0 15, AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> RESTRICTION <br /> 016. ANNUAL INTEGRITY TEST(0.1 GPH) 0 16. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 017. DAILY VISUAL CHECK 0 I DAILY VISUAL CHECK <br /> Vlll.DISPENSER CONTAINMENT <br /> DISPENSER 01. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04.DAILY VISUAL CHECK <br /> CONTAINMENT <br /> DATEINSTALLED 466 02. CONTINUOUS DISPENSER PAN SENSOR*AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER I MONITORING <br /> 1998 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER. 06.NONE 469 <br /> AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SI TURE OF OIWNER/OPEPATOR DATE _ �3 470 <br /> NAME OF O NER/O BATOR(print) TITLE OF OWNERIOPERATOR 472 <br /> Randy Martin I Environmental Manager <br /> Permit Number(For local use only) 473 Permit Approved(For local use only) Permit Expiration Date(For local use only) <br /> 475 <br /> UPCF(1/99 revised) Formerly SWRCB Form B <br />