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Aldk AIM v NIFIED PROGRAM CONSOLIDATED FORM - - TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check e4 Mal appy) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1. PRESSURE 112. SUCTION ❑ 3. GRAVITY_ ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ L SINGLE WALL ❑ 3. LINEDTRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑N. UNKNOWN MANUFACTURER 0a 2. DOUBLEWALL ❑95. UNKNOYM ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ B. FRP COMPATIBLE W/100%METHANOL ❑ 1, BARE STEEL ❑ 6. FRPCOMPATIBLEW/100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION pp/t❑��33. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXISLE(HOPE) ON. OTHER aa . FIBERGLASS ❑ B. FLE%IBLE(HOPE) 11 N' OTHER ❑ 4. FIBERGLASS ❑ B. CATHODIC PROTECTION ❑ 5. STEELWICOATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING El 95, UNKNOWN VII.PIPING LEAK DETECTION(Clock a6fhaf apply) - UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chack al that appy): PRESSURIZED PIPING(Check all'hat appy). - ❑ 1. ELECTRONIC UNE LEAK DETECTOR 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 AUDIBLE AND VISUAL ALARMS ALARMS ❑ EST 2. MONTHLY 0.2 GPM TEST ❑ 3. ANNUAL INTEGRITY TES ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK - CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check ed that apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ 6. TRIENNIAL INTEGRITY TEST to i GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)'. SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELF MONITORING ❑ T. SELFMONITORING GRAVITY FLOW: GRAVITY FLOW(Checka t that apply): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ 6. DAILY VISUAL MONITORING ❑ 9. BIENNIALINTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that appy): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (LNNTI one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(none) ❑-� WH ake. AUTO PUMP SHUT OFF EN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS DIP b. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ b, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUOTIONIGRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUALAIARMS EMERGENCY GENERATORS ONLY(Check aeflrat appy) EMERGENCY GENERATORS ONLY(Check a Mat apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF i AUDIBLE AND ❑ 14.CONTINUOUS SUMP SENSOR`MTHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 16.ANNUAL INTEGRITY TEST(0 1 GPM) ❑ IT DAILY VISUAL CHECK ❑ 1T. DAILY VISUAL CHECK VIIL.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR,AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER/MONITORING �3. CONTINUOUS DISPENSER PAN SENSOR`MTH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ e. NONE IX.OWNER/OPERATOR SIGNATURE I cony Nal Me uVortrafion proN4e4 herein is two a late to Na beat of my knova edge. SIGMA OF ERIOPE OR DATE 31 DI NAME 0 O OPERATOR(Pont) TITLE OF OWN&RvOPERATOR ��/s Permit Number(For local use onW Permit Approved(Forlocal uss only) U Pemet Expiration Data(Forlocal use only) CUPAFORM(4/99) 0 0 Formerly SWRCB Form B