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.)NlFiED PROGRAM CONSOLIDATED Fr 'M TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Chea all that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE N 1.PRESSURE ❑2.SUCTION 0 3.GRAVITY 458 0 1.PRESSURE [12. SUCTION 0 3.GRAVITY 459 CONSTRUCTION] ❑1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 [11.SINGLE WALL 0 95.UNKNOWN 462 MANUFACTURER N 2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER MANUFACTURER Smith Red Thread II 461 MANUFACTURER 463 0 L BARE STEEL N 6.FRP COMPATIBLE wH00% METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE W1100%METRA l 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL 0 3.PLASTIC COMPATIBLE W1 CONTENTS 0 99. OTHER 0 3. PLASTIC COMPATIBLE WI CONTENTS 0 B.FLEXIBLE(HOPE) 0 99. OTHER 0 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) [14. FIBERGLASS 0 9.CATHODIC PROTECTION 0 5.STEEL WICOATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING 0 95.UNKNOWN 465 VII.PIPING LEAK DETECTION(Check a6 that appy)(A description of the monitoring program shall be submitted to the local agers y.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 4% SINGLE WALL PIPING 467 PRESSURIZED PIPING(Checka8 matepPlyk PRESSURIZED PIPING(Check an mat apply): 01. ELECTRONIC LINE LEAK DETECTOR 30 GPH TEST WITH AUTO PUMP SHUT OFF FOR 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL ALARMS. ALARMS. [12. MONTHLY 0.2 GPH TEST 02. MONTHLY 0.2 GPH TEST 03. ANNUAL INTEGRITY TEST(0,1GPH) ❑3. ANNUAL INTEGRITY TEST(O.IGPH) 04. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check m that apply) 05. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY 05. 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. SELFMONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELFMONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Ched,al tiatyply): ❑8. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that appy): PRESSURIZED PIPING(Check ell 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 oral (Civx*one) Na. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Oa AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [1b. ALTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Oc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF N 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR 011, AUTOMATIC LEAK DETECTOR RESTRICTION 012. ANNUAL INTEGRITY TEST(0.1 GPH) 012. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTIONIGRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chea,all mat appy) EMERGENCY GENERATORS ONLY(Check all mat apply) 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND 014. CONTINUOUS SUMP SENSORTWI HOUT AUTO PUMP SHUT OFF*AUDIBLE AND VISUAL ALARMS VISUAL ALARMS 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION 016, ANNUAL INTEGRITY TEST(0.1 GPH) 016. ANNUAL INTEGRITY TEST(0.1 GPH) 017. DAILY VISUAL CHECK 017. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 0 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK DATE INSTALLED 468 02. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER I MONITORING August 23 03, CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ 0 6.NONE 469 AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE loss that the ormation provided is two aM accurate to the best of mY knowledge. SIGJATYEHE OF OWNE OPE DATE 470 7- /- Oa- NAME OF O R7 PRATOR(print) TITLE OF OWNERIOPERATOR 472 Craig B nt I Project Manager, Fillner Construction, Inc. Permit Number(For local use only) 473 Permit Approved(For local use only) Penni)Expiration Dale(For local use only) 475 UPCF(1/99 revised) Formerly SWRCB Form B