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I " IED PROGRAM CONSOLIDATED F w �•„T TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION Check a0 thin apply) Page_of_ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 0 L PRESSURE O 2.SUCTION O 3.GRAVITY 458 0 1.PRESSURE 1-12. SUCTION [:13.GRAVITY 459 CONSTRUCTION 0 1.SINGLE WALL [13.LINED TRENCH 0 99.OTHER 460 0 1.SINGLE WALL O 95.UNKNOWN 462 MANUFACTURER 0 2.DOUBLE WALL O 95.UNKNOWN O 2,DOUBLE WALL 0 99.OTHER MANUFACTURER 461 MANUFACTURER 463 O 1.BARE STEEL O 6.FRP COMPATIBLE w11005E METHANOL 0 1.BARE STEEL ❑6.FRP COMPATIBLE W/IOQ%METHANOL [12.STAINLESS STEEL O 7.GALVANIZED STEEL I 0 Unknown O 2. STAINLESS STEEL ❑7.GALVANIZED STEEL O 3.PLASTIC COMPATIBLE W/CONTENTS O 99. Otter O 3. PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPE) Q 99. OTHER 0 4.FIBERGLASS 0 S.FLEXIBLE(HDPE) [14. FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING O 9.CATHODIC PROTECTION 464 O 5. STEEL W/COATING ❑95.UNKNOWN 465 VD.PIPING LEAK DETECTION(Check 0 that I)(A option of the inanduning progriano shalt h submaaM to the local .) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check 01 ttwt apply): ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT [11. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. O 2.MONTHLY 0.2 GPH TEST [12. MONTHLY 0.2 GPH TEST O 3.ANNUAL INTEGRITY TEST(O.IGPH) [13.ANNUAL INTEGRITY TEST(O.IGPH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all ihm apply) O 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPH) 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELFMONITORING O 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): 0 S. DAILY VISUAL MONITORING [19, BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check ell the apply} PRESSURIZED PIPING(Check all th4t apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check o.) ALARMS AND(Oack oat) 0a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM O b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Oc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR(30 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑11. AUTOMATIC LEAK DETECTOR ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) O 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM M13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check nal the apply) EMERGENCY GENERATORS ONLY(Chock all that apply) O 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF" 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ SHUT OFF OR RESTRICTION I5. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) O 16.ANNUAL INTEGRITY TEST(0.1 GPH) O 16.ANNUAL INTEGRITY TEST(0.1 GPH) 017. DAILY VISUAL CHECK 017. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT L FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 T DAILY VISUAL CHECK DATE INSTALLED 468 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING O 3.CONTINUOUS DISPENSER PAN SENSOR W TTH AUTO SHUT OFF FOR 6.NONE DISPENSER+AUDIBLE AND VISUAL ALARMS ❑ 469 I%.OWNER/OPERATOR SIGNATURE I certify this the iN'ormatlon provided herein is nue and accurate to the best army knowkdge. SIGNATURE OF OWNER/OPo- / ERATOR DATE 470 N oCo ff' e ( � 09- 08 - 06 ANOFO ATOR(pn TITLE OFAWN&R/0P6kk4'Blr'y$�i'-FN 472 S s UPCF 99 revised) / 175 Formerly SWRCB Form B