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F 'M <br /> 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 N 1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 456 D 1.PRESSURE [12. SUCTION [13 GRAVITY 459 <br /> CONSTRUCTION I D 1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 0 1.SINGLE WALL ❑95.UNKNOWN 462 <br /> MANUFACTURER N 2.DOUBLE WALL 0 95.UNKNOWN D 2,DOUBLE WALL [199.OTHER <br /> MANUFACTURER Smith Red Thread II 461 MANUFACTURER 463 <br /> 0 1,BARE STEEL N 6.FRP COMPATIBLE w1100% METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE W/100%METHAeot <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN 0 2. STAINLESS STEEL [17.GALVANIZED STEEL <br /> [13.PLASTIC COMPATIBLE W1 CONTENTS 099. OTHER 0 3. PLASTIC COMPATIBLE W/CONTENTS D 8.FLEXIBLE(HDPE) D 99. OTHER <br /> 0 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) 0 4. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL WICOATING 0 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION(Check all that apply)(A description of Una momais in <br /> 0 Program shall be submb'VEGRed to O 'oral agenq.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Choxap Instability): PRESSURIZED PIPING(Check all that apply): <br /> D1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR 01. 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 0 2. 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 a1 that appy) <br /> D5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY <br /> TEST(0.1 GPH) D5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW [17. SELF MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check as msalgly): <br /> 08. DAILY VISUAL MONITORING <br /> D9. 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 SENSORIAS AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDI BLE AND VISUAL ALARMS AND <br /> (Chari ore' (Check ono) <br /> Na, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> Ob. 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 0c NO AUTO PUMP SHUT OFF <br /> N 11. AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR 011 AUTOMATIC LEAK DETECTOR <br /> RESTRICTION <br /> 012. ANNUAL INTEGRITY TEST(0.1 GPH) 012. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTIOWGRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all mat apply) EMERGENCY GENERATORS ONLY(Cheri all that apply) - <br /> 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND D14. 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 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 /> D 17. DAILY VISUAL CHECK 0 17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER 0 1_ FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE D 4.DAILY VISUAL CHECK <br /> CONTAINMENT <br /> DATEINSTALLED 468 D2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE ANDVISUAL ALARMS D5.TRENCH UNER/MONITORING <br /> August 2003 03 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER <br /> g AUDIBLE AND VISUAL ALARMS ❑6.NONE 469 <br /> IX.OWNER/OPERATOR SIGNATURE <br /> I bodily m he snion iflon provided here u true arxi accurate to me best of my knowledge. <br /> SIGNAT RE OWNhK;4EFjI DATE 470 <br /> 7- /- o3 <br /> NAME OF O R/O RATOR(print) TITLE OF OWNERIOPERATOR 472 <br /> Craig Bell,"Agent I Project Manager, Fillner Construction, Inc. <br /> Permit Number(For kval 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 8 <br />