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AIR1, iFIED PROGRAM CONSOLIDATED FOR TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check a9 Matappy) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1 PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTIOW ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑B5. UNKNOWN MANUFACTURER 2. DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99.OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL B. FRP COMPATIBLE WI 100%METHANOL ❑ 1. BARE STEEL ❑ 5. FRP COMPATIBLE W/iW%METHANOL MATERIALSAND ❑ 2. STAINLESS STEEL ❑ ). GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 1195. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ S. FLEXIBLE(HDPE) 1199. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION ID 5. STEEL WI COATING 1195. UNKNOWN VII.PIPING LEAK DETECTION(Crock a0 niatapply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALLPIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check as Mal appy): PRESSURIZED PIPING(Chad all Mat apply): ❑ 1. ELECTRONIC LINE LEAK DEFECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDISLE AND VISUAL ALARMS ALARMS 11132 MONTHLY 0.2 GPM TEST 11 2. MONTHLY GPT TEST 3. ANNUAL INTEGRITY GRITY TEST(0.1 GPN) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Chad all that appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ 5. TRIENNIAL INTEGRITY TEST(ol GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)'. ❑ T. SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check ad that apply): ❑ 9. BIENNIAL INTEGRITY TEST to 1 GPM) ❑ S. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that appy): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS ANDjCheck one) 10.CONTINUOUS TURBINE SUMP SENSOR VATH AUDIBLE AND VISUAL ALARMS AND(Fhee,one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b.AUTO PUMP SHUTOFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION 13b. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ C. NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TESTI WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONIGRAVITY SYSTEM'. SUCTION/GRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check as that apply) EMERGENCY GENERATORS ONLY(Check ON Mat appy) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUALAIARMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3 0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 15.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 15. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 11. DAILY VISUAL CHECK 11317, DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK A E,INSTALLED ❑ 2. 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 ❑ 5. NONE I%.OWNER/OPERATOR SIGNATURE I teNly Mal Me infonnaton provided herein is into and accurate to Me bast of my Imoate ige. SIGNATURE OF OWNERIOPERATOR DATE NAME OF OWNERIOPERATOR(prtnU TITLE OF OWNERIOPERATOR Permit Number(Por kcal use cold Permit Approved!(For local use onyU front Evirallon Date(ForIkFal use ortly) a a of��°-tea CUPAFORM 4/99 Form OY SWRCB Form 8