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VIED PROGRAM CONSOLIDATED FO' �v' <br /> / X07 ( TANK <br /> UNDERGROUND STORAGE TANKS - TANKPAGE 2 <br /> VI.PIPING CONSTRUCTION(check all that apply) Paye _ or <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE M 1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 166 01.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 <br /> CONSTRUCTION/ 171.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 450 01.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER M 2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER UNK 451 MANUFACTURER 463 <br /> 01.BARE STEEL 0 6.FRP COMPATIBLE w1100% METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE W1100%METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 03.PLASTIC COMPATIBLE W/CONTENTS 099. OTHER 03. PLASTIC COMPATIBLE WI CONTENTS 08.FLEXIBLE(HI 099. OTHER <br /> M 4.FIBERGLASS 0 B.FLEXIBLE(HDPE) 0 4. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL WMAATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING 0 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETEC71ON(check ell that A deemPlict,afire monitodn ram shall be submibee to the locel a en .) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURVED PIPING(cedrr alaa7py): PRESSURIZED PIPING(check an that apply): <br /> 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST MrB AUTO PUMP SHUT OFF FOR 01. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST WLIH AUTO PUMP SHUT OFF FOR <br /> LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL <br /> ALARMS. ALARMS. <br /> [32. MONTHLY 0.2 GPH TEST [32, MONTHLY 0.2 GPH TEST <br /> 03. ANNUAL INTEGRITY TEST(0.1GPH) 03. ANNUAL INTEGRITY TEST(0.1GPH) <br /> [14, DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chea al wa&") <br /> 05. DAILY MSUALMONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY <br /> TEST(0.1 GPH) O5. DAILY VISUAL MONITORING Of PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPINGI 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> 0 7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 0 7. SELF MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Clack ek Net al <br /> 08 DAILY VISUAL MONITORING <br /> 09 BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURZED PIPING(Check an Net appy): PRESSURIZED PIPING(Check all Nat apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR Mjd AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br /> Pm*-) (Chad") <br /> 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 e AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> Ob. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM Ob AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> Md. NOAUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> 011. AUTOMATIC LINE LEAK DETECTOR(&0 GPH TEST)M FLOW SHUTOFF OR <br /> ❑ <br /> RESTRICTION 11. AUTOMATIC LEAK DETECTOR <br /> ;1'12. ANNUAL INTEGRITY TEST(0.1 GPH) [312. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTIONIGRAVITY SYSTEM SUCTIOWGHAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that appy) EMERGENCY GENERATORS ONLY(Check an Nat apply) <br /> 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND 014. CONTINUOUS SUMP SENSORI' THT ,Q}(j AUTO PUMP SHUT OFF.AUDIBLE AND <br /> VISUALALARMS ASUALALARMS <br /> 015.AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)WM40UT FLOW SHUT OFF OR <br /> RESTRICTION 015. AUTOMATIC LINE LEAN DETECTOR(3.0 GPH TEST) <br /> 016. ANNUAL INTEGRITY TEST(0.1 GPH) 016. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 017. DAILY VISUAL CHECK 017. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER 91 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE <br /> CONTAINMENT ❑4.DAILY VISUAL CHECK <br /> DATE INSTALLED 466 02. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 S.TRENCH LINER/MONITORING <br /> 99 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ D6.NONE a69 <br /> AUDIBLE AND VISUAL ALARMS <br /> DL OWNERIOPERATOR SIGNATURE <br /> I certify Nat the lntwmatlm n Is true and accurate W the beet of my krpMedge. <br /> SIGNATURE OF N E TOR ♦ DATE 470 <br /> 4/28/07 <br /> NAME OF OW O pnm) TITLE OF OWNER/OPERATOR 472 <br /> Cindy Hughes Madrid General Manager, Retail Services <br /> Permt Number To,local use only) 473 Per t Approved For local me poly) Permit Expiration Oate(For local use only) <br /> 475 <br /> 1(12/99 revised) Formerly SWRCB Form B <br />