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TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Chrar all that apply) Poe_ of <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 01.PRESSURE D 2.SUCTION 0 3.GRAVITY 458 0 1.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 <br /> CONSTRUCTION/ D 1.SINGLE WALL D 3.LINED TRENCH 0 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 Smith Red Thread II 461 MANUFACTURER 463 <br /> _D1.BARE STEEL ®6.FRP COMPATIBLE w1100% METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE wn6o%METHANOL <br /> D 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN D 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 03.PLASTIC COMPATIBLE W/CONTENTS 099. OTHER 03. PLASTIC COMPATIBLE WI CONTENTS 08.FLEXIBLE(HDPE) 099. OTHER <br /> D 4.FIBERGLASS 0 6.FLEXIBLE(HDPE) 0 4. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> D 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 CIS. STEEL W/COATING 0 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION(Check en that apply)(A daeuipl,,of the mmkorkV porem ahe0 ce aularn,Ked W the looal agency.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Clark a Na appy)' PRESSURIZED PIPING(Check all that apply). <br /> D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST NTH AUTO PUMP SHUT OFF FOR [11. 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 /> D3. ANNUAL INTEGRITY TEST(0.1GPH) 03. ANNUAL INTEGRITY TEST(0.1GPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Clock a that apply) <br /> D5. ONLY 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 07. SELFMONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check a that apply): <br /> 08. DAILY VISUAL MONITORING <br /> [19. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check a0 to o appy): PRESSURIZED PIPING(Cheat all that appy): <br /> 10. CONTINUOUS TURBINE SUMP SENSORIN) H AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br /> (Ch "I (Clack oro) <br /> ®a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0a 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 /> 0C. NO AUTO PUMP SHUT OFF 0c NO AUTO PUMP SHUT OFF <br /> 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR 0 11, AUTOMATIC LEAK DETECTOR <br /> RESTRICTION <br /> 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) [112. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTIONIGRAVITY 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 appy) EMERGENCY GENERATORS ONLY(Check all that appy) <br /> 014. CONTINUOUS SUMP SENSOR WITHO AUTO PUMP SHUT OFF-AUDIBLE AND 014. CONTINUOUS SUMP SENSOR WITH U AUTO PUMP SHUT OFF.AUDIBLE AND <br /> VISUAL ALARMS VISUAL ALARMS <br /> 0 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> RESTRICTION <br /> 016. ANNUAL INTEGRITY TEST(0.1 GPH) 016. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 017 DAILY VISUAL CHECK 0 17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER <br /> CONTAINMENT 0 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4.DAILY VISUAL CHECK <br /> DATEINSTALLED 466 D2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER I MONITORING <br /> August 2003 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER. 0 6.NONE 469 <br /> AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> 1 ttd4y me' matron provided e a true and e=rate to the best of my knowledge. <br /> SIGN TU OF OWNE OPE DATE I Q� 470 <br /> NAME OF E OPRATOR(print) TITLE OF OWNER/OPERATOR 472 <br /> Craig BkL_6@bnt Project Manager, Fillner Construction, Inc. <br /> Permit Numbar(For local use only) 473 Permit Approved For local use only) Permit Expiration Data(For l0®1 use only) <br /> 475 <br /> UPCF(1/99 revised) Formerly SWRCB Form B <br />