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r NIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 pace VI.PIPING CONSTRUCTION(Chack.0 Matapo)� _ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTIOW ❑ 1. SINGLE WALL ❑ 3. LINEDTRENCH E199 OTHER ❑ 1. SINGLE WALL 1195. UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL 1195, UNKNOWN ❑ 2. DOUSLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ e. FRP COMPATIBLE WI 1M%METHANOL ❑ 1. BARE STEEL ❑ e. FRP COMPATIBLE W1 100%METHANOL MATERIALSAND ❑ 2. STAINLESS STEEL GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ ]. GALVANIZED STEEL PROTECT CORRO ION N ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 13 95. UNKNOWN 113. PLASTIC COMPATIBLE WITH CONTENTS El e. FLEXIBLE(HDPE) 13 99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE(HDPE) 13 99, OTHER ❑ 4. FIBERGIASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WICOATING 1:195. UNKNOWN VIL PIPING LEAK DETECTION fCheck ad INN appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Cha0 ad that apply): PRESSURIZED PIPING(Chack all that apply): - ❑ 1. ELECTRONIC LINE 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 C12. MONTHLY 0.2 GPM TEST El 2. MONTHLY 02 GPM TEST _ ❑ 3.ANNUAL INTEGRITY TEST IDA GPM) 133.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all Mat apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) ❑ 8. TRIENNIAL INTEGRITY TEST(0.I GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)'. ❑ ]. SELF MONITORING ❑ ]. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check a0 that appy): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check a1/Ihat appy): PRESSURIZED PIPING(Check 00 Mal apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Uleck one) ❑ e. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b. AUTO PUMP NNECTION SHUT OFF FOR LEANS.SYSTEM FAILURE AND SYSTEM DISCONNECTION 13b, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DIS ❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SMUT OFF OR RESTRICTION 1111. AUTOMATIC LEAK DETECTOR ❑ 12.ANNUAL INTEGRITY TEST(a 1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONA33RAVITY SYSTEM'. SUCTIONIGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check M Mat appy) EMERGENCY GENERATORS ONLY(Check all flat appy) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DEFECTOR(3.0 GPM TEST) RESTRICTION ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 1]. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILYVISUALCHECK DATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS NONE IX.OWNERIOPERATOR SIGNATURE I ca9fy that 0e Information pmviae0 heroin is tme anp 9Uunla to Ne best of my krwwlaO9e. SIGNATUREOFOWNERIOPERATORDATE NAME OF OWNER/OPERATOR(pnnU TITLE OF OWNERIOPERATOR Permit Number(For tical use only) Permit AppmvW(Forklcal use ow Permit Expbation Data(F4rho*1 uae oMy) CUPAFORM(4/99) Formerly SWRCB Form B