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VIED PROGRAM CONSOLIDATED FOr j b� J <br /> �. k/)4 /01 �-/P TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(cher*all that apply) Page <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE ®1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 168 01.PRESSURE 0 2. SUCTION 0 3.GRAVITY 469 <br /> CONSTRUCTION 1 01.SINGLE WALL O 3.UNED TRENCH O 99.OTHER 188 [11.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER 0 2 DOUBLE WALL 0 95.UNKNOWN 0 2.DOABLE WALL 0 99.OTHER <br /> MANUFACTURER LINK 461 MANUFACTURER 463 <br /> 01,BARE STEEL 0 6.FRP COMPATIBLE W/16D% METHOWU 01.BARE STEEL 0 6.FRP COMPATIBLE Wnog%ME1wNOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN [12. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPATIBLE W/CONTENTS 0 99. OTHER 0 3. PLASTIC COMPATIBLE W/CONTENTS 0 B.FLEXIBLE(HDPE) 0 99. OTHER <br /> ®4.FIBERGLASS 0 B.FLEXIBLE(HDPE) 0 4. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL W7COATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL WICOATING 0 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION(Check all met apps (A desaip6pn of the monRcnn2 program shall be submitted to the local en .) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING My <br /> PRESSURIZED PIPING(Chea,al may apply): PRESSURIZED PIPING(Check all mal apply): <br /> ❑1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST NIH AUTO PUMP SHUT OFF FOR 01, ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST WITH 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 0 2. MONTHLY 0.2 GPH TEST <br /> 03, ANNUAL INTEGRITY TEST(0.1GPH) 0 3. ANNUAL INTEGRITY TEST(0.1GPH) <br /> [34. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Cleak al eatappy) <br /> 05. DAILY VISUAL MONITORING 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 GROUNDPIPING): 06. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [37. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW [17. SELF MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Chwa al that apply): <br /> 08. DAILY VISUAL MONITORING <br /> 09 BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check a6 that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE ANDVISUAL ALARMS AND 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br /> pled'one) (Chxk M) <br /> 0& AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 b. 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 /> ®C. NO AUTO PURAP SHUT OFF OC NO AUTO PUMP SHUT OFF <br /> ®11. AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)WB ROW SHUTOFF OR <br /> RESTRICTION ❑11. AUTOMATIC LEAK DETECTOR <br /> 12 ANNUAL INTEGRITY TEST(0.1 GPH) 012. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTIOWGRAVITY SYSTEM SUCTIOWGRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Chea al But apply) EMERGENCY GENERATORS ONLY(Chea all mat apply) <br /> 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND <br /> VISUALALARMS VISUALALARMS <br /> 015.AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)NTH QYI FLOW SHUT OFF OR <br /> RESTRICTION 015. AUTOMATIC UNE LEAK 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 01. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04 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 WITH AUTO SHUT OFF FOR DISPENSER- 0 6.NONE 469 <br /> AUDIBLE AND VISUAL ALARMS <br /> DL OWNER/OPERATOR SIGNATURE <br /> I cenmy mat me iMormadon pnryi a Wn as true Md acwnte to the beat d my knowledge. <br /> SIGNATURE OF OWNE OR r ♦ DATE 470 <br /> a. 4/28/07 <br /> NAME OF OW M - TITLE OF OWNER/OPERATOR 472 <br /> Cindy u hes Madrid General Manager, Retail Services <br /> Pennit Number(For local use only) 473 Pea t Approved(For Iooal use only) Permit Erpimadn Date Per local use only) <br /> 475 <br /> UPCF(12/99 revised) Formerly SWRCB Form B <br />