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L IED PROGRAM CONSOLIDATED FOR[ TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all that appy) Pape- of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 158 ❑1.PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 CONSTRUCTION/ ❑T SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER MO ❑1.SINGLE WALL ❑95.UNKNOWN 462 MANUFACTURER 0 2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER Environ 461 MANUFACTURER_ 463 ❑1.BARE STEEL ❑6.FRP COMPATIBLE w/100% METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE Wy10016METHANOI ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑UKNOWN ❑2. STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑99. OTHER [13. PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPE) 0 99. OTHER ®4.FIBERGLASS ®8.FLEXIBLE(HDPE) ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 464 [15. STEEL WICOATING ❑95.UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that apply)(Ades ption of the monitonng program shall be submitted to the localagency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all mat apply): PRESSURIZED PIPING(Check an that apply): ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR El 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE ANDVISUAL LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. ALARMS. ❑2. MONTHLY 0.2 GPH TEST [:12. MONTHLY 0.2 GPH TEST ❑3. ANNUAL INTEGRITY TEST(0.1GPH) [13. ANNUAL INTEGRITY TEST(0AGPH) []4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check atl matappty) ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY []5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELFMONITORING 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all mMapply): ❑8. DAILY VISUAL MONITORING [19. 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 one) (Check one) []& 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 ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Oc. NOAUTOPUMPSHUTOFF Cc NO AUTO PUMP SHUT OFF ®11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR []11. AUTOMATIC LEAK DETECTOR RESTRICTION ®12. ANNUAL INTEGRITY TEST(0.1 GPH) [112. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all mat apply) EMERGENCY GENERATORS ONLY(Check all that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ALARMS VISUAL ALARMS [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION C3 16, ANNUAL INTEGRITY TEST(0.1 GPH) 016. ANNUAL INTEGRITY TEST(0.1 GPH) 017. DAILY VISUAL CHECK El 17. DAILY VISUAL CHECK Vlll.DISPENSER CONTAINMENT DISPENSER ❑1, FLOAT MECHANISM THAT SHUTS OFF SHEARVALVE [14.DAILY VISUAL CHECK CONTAINMENT DATEINSTALLED 468 02. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS []5.TRENCH UNER I MONITORING 1998 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ 0 6,NONE 469 AUDIBLE AND VISUAL ALARMS IX.OWNERIOPERATOR SIGNATURE ' I pettily that the information provided herein Is true are accurate to the best of my knowledge. SIGNATUE�-0F'DWNER/OP RAT DATE -A- O 470 L O NAME OF OWNER/OPRATOR(pant) TITLE OF OWNERIOPERATOR 472 tan Moorhead I Region Gasoline Environmental Compliance Manager Pe"t Number(For local use only) 473 Pernit Approyed(For local use only) Permit Expiration Date(For local use only) 475 UPCF(1/99 revised) Formerly SWRCB Form B