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L "IED PROGRAM CONSOLIDATED FOR <br /> wit TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Check all that apply) Page _of <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 0 1.PRESSURE D 2,SUCTION D 3,GRAVITY 458 D 1.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 <br /> CONSTRUCTION/ 0 1.SINGLE WALL D 3.LINED TRENCH D 99.OTHER 460 0 1.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER 0 2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER Environ 461 MANUFACTURER 4W <br /> D 1,BARE STEEL 0 6.FRP COMPATIBLE w/1DD% METHANOL 01.BARE STEEL 0 6.FRP COMPATIBLE W1100%METHANOL <br /> 02.STAINLESS STEEL 07.GALVANIZED STEEL 0UKNOWN 02. STAINLESS STEEL 07.GALVANIZED STEEL <br /> 03.PLASTIC COMPATIBLE W1 CONTENTS D99. OTHER D3. PLASTIC COMPATIBLE Wit CONTENTS 08.FLEXIBLE(HOPE) 099. OTHER <br /> ®4.FIBERGLASS 0 8.FLEXIBLE(HDPE) D 4. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> D 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 D 5. STEEL W/COATING El 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION(Cheek an 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(CAerkall thatappy): PRESSURIZED PIPING(Check all that apply): <br /> 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR Di. 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(0,1GPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all 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): [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> 07. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 0 7. SELF MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW ICiwckallthatappry): <br /> [18. DAILY VISUAL MONITORING <br /> [19, 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 SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br /> (Check ane) KA I,*0") <br /> 0a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Oa AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> ®b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM D b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> Dc. NOAUTO PUMP SHUT OFF Dc NO AUTO PUMP SHUT OFF <br /> 159 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR 0 It. AUTOMATIC LEAK DETECTOR <br /> RESTRICTION <br /> ®12. ANNUAL INTEGRITY TEST(0.1 GPH) 012. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> ❑13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Cheek all that apply) EMERGENCY GENERATORS ONLY(Cheek all that appy) <br /> 14 CONTINUOUS CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND <br /> VISUAL ALARMS VISUAL ALARMS <br /> 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> RESTRICTION <br /> [116. ANNUAL INTEGRITY TEST(0.1 GPH) [116. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 017. DAILY VISUAL CHECK 017. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER 01. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04.DAILY VISUAL CHECK <br /> CONTAINMENT <br /> DATEINSTALLED 468 02. CONTINUOUS DISPENSER PAN SENSOR*AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER/MONITORING <br /> 1998 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER. 0 6.NONE 469 <br /> AUDIBLE AND VISUAL ALARMS <br /> IX.OWNERIOPERATOR SIGNATURE <br /> I cer0ty that the information provded herein is We and accurate to the best of my knowledge. <br /> SIGNATURE-OF OWNER/OPE R DATE 470 <br /> 1 r. 0225/08' <br /> NAME OF OWNER/OPRATOR(print) TITLE OF OWNER/OPERATOR 472 <br /> Ian Moorhead Region Gasoline Environmental Compliance 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 />