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VIED PROGRAM CONSOLIDATED FO' ' (� D-1 <br /> '' Ce)l+) O`7 kQ TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Check an mat apply) Page _ of_ <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE ®1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 458 0 1.PRESSURE 0 2. SUCTION 0 3.GRAVITY 450 <br /> CONSTRUCTION/ 01.SINGLE WALL 0 3.UNED TRENCH 0 99.OTHER 460 0 1.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER 0 2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL O 99.OTHER <br /> MANUFACTURER K 461 MANUFACTURER 463 <br /> 01.BARE STEEL 0 6.FRP COMPATIBLE W/196% AEMANOL 0 1.BARE STEEL 0 6 FRP COMPATIBLE WI MErHAN0L <br /> 0 2 STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 03.PLASTIC COMFATIBLE WI CONTENTS 099. OTHER 03. PLASTIC COMPATIBLE W/CONTENTS 08.FLEXIBLE(HOPE) 099. OTHER <br /> 04.RBERGLASS 0S.REIOBLE(HOPE) 04. FIBERGLASS 09 CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 0 S. STEEL W/COATING 0 95.UNKNOWN 465 <br /> VL PIPING LEAK DETECTION(Check an mat A easeltake of the monitoring pro9rem she be submitted to the low .) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check+elrpply): PRESSURIZED PIPING(Check an that apply): <br /> 01. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST MM AUTO PUMP SHUT OFF FOR 01. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST EM 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 /> 02. MONTHLY 0.2 GPH TEST 02. MONTHLY 0.2 GPH TEST <br /> 03, ANNUAL INTEGRITY TEST(0AGPH) 03. ANNUAL INTEGRITY TEST(0.1GPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS pod as met ypty) <br /> 05. DAILY VISUAL MONITORING OF PUMPING SYSTEM,TRIENNIAL PIPING INTEGRITY 05. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 06, TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [37. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW [37. SELF MONITORING <br /> C39. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(I dmrppyO: <br /> O6. DAILY VISUAL MONITORING <br /> [19. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Chea all that apply): PRESSURIZED PIPING(Check as that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR MM AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR NTH AUDIBLE AND VISUAL ALARMS AND <br /> Pass") (Chlack anal <br /> Oa. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Oa 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 /> II NO AUTO PUMP SHUT OFF Cc NO AUTO PUMP SHUT OFF <br /> 011. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)Mb FLOW SHUTOFF OR <br /> ❑ <br /> :,RESTRICTION 11. AUTOMATIC LEAK DETECTOR <br /> 12. ANNUAL INTEGRITY TEST(0.1 GPH) 012 ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTIOWGRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Chea ell that apply) EMERGENCY GENERATORS ONLY(Check all the apply) <br /> 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND 014. CONTINUOUS SUMP SENSOR W1THIXfT AUTO PUMP SHUT OFF.AUDIBLE AND <br /> VISUALALARMS VISUAL ALARMS <br /> 015.AUTOMATIC UNE LEAK DETECTOR 13.0 GPH TEST)yy1jHQUj FLOW SHUT OFF OR 015. AUTOMATIC UNE LEAK DETECTOR 3 0 GPH TES <br /> RESTRICTION ( T) <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 ®1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4.DAILY VISUAL CHECK <br /> CONTAINMENT <br /> DATEINSTALLED 468 02. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER/MONITORING <br /> 1999 0 3. CONTINUOUS DISPENSER PAN SENSOR MM AUTO SHUT OFF FOR DISPENSER 0 6.NONE 469 <br /> AUDIBLE AND VISUAL ALARMS <br /> DL OWNERIOPERATOR SIGNATURE <br /> 1011 are the Information W0001001 Is hue arq accurate to the peat of my knokvladpa. <br /> SIGNATURE OFOW E • DATE 470 <br /> 4/28/07 <br /> NAME OF OWN ) TITLE OF OWNERIOPERATOR 472 <br /> QndX Hughes Madrid General Manager, Retail Services <br /> Permit Number(For local use only) 473 Permit Approved(For local use only) Penal EVirabon Dale(For local use only) <br /> 475 <br /> UPCF(12/99 revised) Formerly SWRCB Form B <br />