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OIFIED PROGRAM CONSOLIDATED FOR TANK: TA0515657 PR p: PRO518829 UNDERGROUND STORAGE TANKS - TANK PAGE 2 FACl/: FA0014175 VI.PIPING CONSTRUCTION(Cbecc e0 mat opph) UNDERGROUND PIPING Page 3 ata SYSTEM TYPE ❑ 1.PRESSUREABOVEGROUND PIPING ®2.SUCTION ❑3.GRAVITY 459 ❑ I.PRESSURE ❑2.SUCTION CONSTRUCTION 111.SINGLE WALL ❑3,LINED TRENCH ❑ 99.OTHER 460 ❑3.GRAVITY 459 ❑2.DOUBLE WALL ❑ I.SINGLE WALL ❑95.UNKNOWN MANUFACTURER [115,UNKNOWN 462 ❑2.DOUBLE WALL El 99.OTHER 461 MANUFACNRER ❑ I.BARE STEEL ❑ 6.FRP COMPATIBLE w/1a9Y.METHANOL El1.BARE STEEL LJ 6,FRP COMPATIBLE iv/I0o/h4THANOL 463 ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑2.STAINLESS STEEL ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 7.GALVANIZED RED STEEL ❑ 4.FIBERGLASS ❑ 95.OTHER ❑4.FIBERGLASS COMPATIBLE W1 CONTENTS ❑ 95.UNKNOWN ❑ S.FLEXIBLE(HDPE) ❑ 99 OTHER ❑4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99,OTHER ❑ 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 464 [15 STEEL W/COATING ❑ 9,CATHODIC PROTECTION VII.PIPING LEAK DETECTION(ChRl;,ll mal 465 aPpl))fA 4eacnplim or:hc monibring pmgrem ahall be aub nmM to me Jowl agccv.) UNDERGROUND PIPING SINGLE WALL PIPING ABOVEGROUND PIPING PRESSURIZED PIPING(Check all that apply): 066 SINGLE WALL PIPING ❑ I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMPRESSURIZED PIPING(Check all that apply): 467 P SHOT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION' AND ❑ 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF VISUAL ALARMS. FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND ❑2.MONTHLY 0.2 GPH TEST VISUAL ALARMS. ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 2_MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0,1 GPH) ❑4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑ S DAILYVISUAL MONITORING OF PUMPING SYSTEM+TRIENNIF.AL INTEGRITY TESL(0.1 GPH) PIPING El5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW IROUNDPIPING): ❑ 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑ 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): GRAVITY FLOW ❑ 7.SELF MONITORING ❑ 9.BIENNIAL.INTEGRITY TEST(0.1)GPH GRAVITY FLOW(Check all that apply): ❑ 8.DAILY VISUAL MONITORING SECONDARILY CONTAINED PIPING ❑ 9_BIENNIAL INTEGRITY TEST(0.1)GPH PRESSURIZED PIPING(Check all that aPP apply): SECONDARILY CONTAINED PIPING ALARMS AND(Chxk anc)CONTINUOUS TURBINEPRESSURIZED PIPING(Check all that apply): ALE SUMP SENSOR W17H ADDIBLE AND VISUAL 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Clark one) ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a.ALTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b.AUTO PUMP SHAT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ a NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR ❑ c. NO AUTO PUMP SHUT OFF RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12.ANNUAL INTEGRITY TEST(0.1 CPN) SUCTION/GRAVITY SYSTEM ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCITOWGRAVITY SYSTEM El13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chcck all ma apply) EMERGENCY GENERATORS ONLY(Check all mat apph9 ❑ 14,CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS SHUT OFF ❑ TLC LME LEAK DETECTOR(3.0 GPH TEST)WITEOUT FLOW ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHOFF O OR RESTRICTION SHUT OFF OR RESTRICTION El16.ANNUAL INTEGRITY TEST(O.I GPH) 17 El VISUAL CHECK 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ . ISPER CON ❑ 17.DAILY VISUAL CHECK VI .DISPENSER CONTAINMENT DATEN STALLETAINMENT ❑ 1 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INSTALLED ❑ 4.DAILY VISUAL CHECK 46g El.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6.NONE LC.OWNER/OPERATOR SIGNATURE 469 Icenifi mato in!axion prmitlM hcmin is une and exwete:o me best ofmv l:roxledge. SIGNATURE OF OWNER/OPERATOR DATE 470 NAME OF OWNER/OPERATOR(pant) JOELLE GOMEZ 471 TITLE OF OPERATOR Permit Numbcr(For1matua,m1y) 473 EXECUTIVE DIRECTOR an Pcmiil APpra�M(Fw Jowl wu only) 474 Permit Evvo:ion Daw(Fw lmal we only) 475 UPCF(12/99 revised)