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-will 7 ✓ �IUL ' U1� yOT APPLICABLE -Waste Oil Tank Remo ,iping Removed during 1998 UST Compliar, p e UNIFIED PROGRAM CONSOLIDATED FORM "IMGA;;l7G'IUT uCn1INC UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all that apply) UNDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE F 1. PRESSURE r 2. SUCTION r 3. GRAVITY r 1. PRESSURE r 2. SUCTION r 3. GRAVITY 459 CONSTRUCTION r 1. SINGLE WALL r 3. LINED TRENCH r99. OTHER r i. SINGLE WALL r95. UNKNOWN 462 / r 2. DOUBLE WALL r95. UNKNOWN r 2. DOUBLEWALL r99. OTHER MANUFACTURE MANUFACTURER 461 MANUFACTURER 463 R r 1.BARE STEEL IF 6. FRP COMPATIBLE W/100%METHANOL r 1. BARE STEEL r 6. FRP COMPATIBLE W/100%METHANOL MATERIALSAND r 2. STAINLESS STEEL r 7. GALVANIZED STEEL r 2. STAINLESS STEEL r 7. GALVANIZED STEEL CORROSION r 3. PLASTIC COMPATIBLE WITH CONTENTS r 95. UNKNOWN r 3. PLASTIC COMPATIBLE WITH CONTENTS r B. FLEXIBLE(HDPE) r 99. OTHER PROTECTION F 4. FIBERGLASS r 8. FLEXIBLE(HOPE) F99 OTHER r 4. FIBERGLASS r 9. CATHODIC PROTECTION IF 5 STEEL W1 COATING r 9 CATHODIC PROTECTION 464r 5 STEEL W1 COATING r95 UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that apply)(A dascripton of the monitoring pmgmm shall be submitted to the local agency) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check al/that apply): PRESSURIZED PIPING(Check all that apply): F 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR r 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION i AUDIBLE AND VISUAL ALARMS ALARMS r 2. MONTHLY 0.2 GPM TEST F 2. MONTHLY 0.2 GPH TEST r 3. ANNUAL INTEGRITY TEST(0.1 GPH) F 3 ANNUAL INTEGRITY TEST(01 GPH) r 4 DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that apply): F S. DAILY VISUAL MONITORING OF PUMPING SYSTEM*TRIENNIAL PIPING INTEGRITY r 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST IDA GPH) r 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) F 7. SELF MONITORING r 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check all that apply): r9. BIENNIAL INTEGRITY TEST(01GPH) r 8 DAILY VISUAL MONITORING r 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(rherk one) Ft one) a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS r a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS r b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM r b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION r c NO AUTO PUMP SHUT OFF r c. NO AUTO PUMP SHUT OFF r 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR r 11. AUTOMATIC LEAK DETECTOR RESTRICTION r 12. ANNUAL INTEGRITY TEST(0.1 GPH) r 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION/GRAVITY SYSTEM: SUCTIOWGRAVITY SYSTEM: r 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS r 13. CONTINUOUS SUMP SENSOR*AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) r 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND r 14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF♦AUDIBLE AND VISUAL VISUAL ALARMS ALARMS F 15 AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR r 15 AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION F 16 ANNUAL INTEGRITY TEST(0.1 GPH) r 16. ANNUAL INTEGRITY TEST(0.1 GPH) F 17 DAILY VISUAL CHECK r 17 DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT r 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE r 4. DAILY VISUAL CHECK DATE INSTALLED 468 r 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS r 5. TRENCH LINER/MONITORING F 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER,AUDIBLE AND VISUAL ALARMS r 6 NONE 469 IX.OWNER/OPERATOR SIGNATURE 1 candy Mat Me information provided herein is true and accurate to the best of.Ty knowledge. .$IGNAjAM OF OWIJERlOPC7R ^ DATE 617102 470 NAME OF OWNER/OPERATOR(pent) 471 TITLE OF OWNER/OPERATOR 472 Bruce T. Marubashi for Shell Oil Products HSE Anal st 926-766-3498 Permit Number(Forkzal use only) 473 I Permd Approved(For focal use only) 474 I Permit Expiration Date(For local use only) 475 8