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} <br /> rrfIFIED PROGRAM CONSOLIDATED FOvw.4 <br /> TANK <br /> UNDERGROUND STORAGE TANKS TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION Check an that awl Page 2 of 6 <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 0 1.PRESSURE [12.SUCTION O 3.GRAVITY 458 0 1.PRESSURE O 2. SUCTION O 3.GRAVITY 459 <br /> CONSTRUCTION 0 1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 0 1.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER 0 2.DOUBLE WALL O 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER AO Smith 461 MANUFACTURER 463 <br /> 0 1.BARE STEEL 0 6.FRP COMPATIBLE w/]0 METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE wno0x MUTIANOL <br /> O 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 Unknown O 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> [13.PLASTIC COMPATIBLE W/CONTENTS [199. Other [11. PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEXIBLE(HDPE) 099. OTHER <br /> ®4.FIBERGLASS O 8.FLEXIBLE(HDPE) [14. FIBERGLASS [19.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING [19.CATHODIC PROTECTION 464 O 5. STEEL W/COATING 0 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION(Check an that apply) Ado ' on ofthc rnotriton.gpoSornshell he wbmflted lythe Mwl nc.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Cheek all that epply): PRESSURIZED PIPING(Cheek all that apply): <br /> 0 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> [12.MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST <br /> 0 3.ANNUAL INTEGRITY TEST(O.IGPH) 0 3.ANNUAL INTEGRITY TEST(O.IGPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(cheek all that apply) <br /> O 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUND PIPING): ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPM <br /> [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELF MONITORING <br /> [19.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Chock all that apply): <br /> 08. DAILY VISUAL MONITORING <br /> 0 9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Cheek all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Check one) <br /> Oa. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> Or. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT <br /> OFF OR RESTRICTION ❑11. AUTOMATIC LEAK DETECTOR <br /> 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) [112. ANNUAL INTEGRITY TEST(0.1 GPM <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> O 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS O 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all then apply) <br /> [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> O 16.ANNUAL INTEGRITY TEST(0.1 GPH) O 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 0 17. DAILY VISUAL CHECK 0 17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 0 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE O 4.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING <br /> 7/11/91 0 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> DC.OWNER/OPERATOR SIGNATURE <br /> I certify than the infomutlon ed here t trve and•••ucene to the bcrt of my ktmwlcdgc. <br /> SIGNATURE OF O T R DATE 470 <br /> Q R,LfEW 6/3/02 <br /> NAME OF OWNER/OPERATOR Tint) TITLE OF OWNERIOPERATOR 472 <br /> Chevron Products Co n /D.R.LERI Retail ESH Specialist <br /> Permit Nu nber(For local uw only) 473 Pemiic Approv4d(For tical use only) Pernut Exp®tion one(For local use only) 475 <br /> UPCF(1/99 revised) 174 Formerly SWRCB Form 13 <br />