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I�FIED PROGRAM CONSOLIDATED FOIv TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(ch«k.n meta I P., °f L)NDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE ®I.PRESSURE [12,SUCTION ❑3.GRAVITY 459 ❑ 1 PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 CONSBUCTION ❑I SINGLE WALT. ❑3.LINED TRENCH ❑99 OTHER 460 ❑ 1 SINGLEWALL ❑95.UNKNOWN 4.2 MANUFACTURER ®2.DOUBLE WALL [195 UNKNOWN ❑2,DOUBLE WALL ❑99.OTHER MANUFACTURER dol MANUFACTURER 403 C)1 BARE STEEL ❑6.FRP COMPATIBLE. wh(ata6 METHANOL ❑ I.BARE STEEL [16,FRP COMPATIBLE W11M METBA1401. [12 STAINLESS STEEL ❑7.GALVANIZrD STEEL I ❑Unknown ❑2. STAINLESS STEEL ❑Z GALVANIZED STEEL [13 PLASTIC COMPATIBLE W/CONTENTS ❑99. Other ❑3. PLASTIC COMPATIBLE W/CONTENTS ❑S.FLEXIBLE(HOPE) ❑99 OTHER 04 FIBERGLASS ❑It FLEXIBLE(HDPE) [14 FIBERGLASS ❑9 CATHODIC PROTECTION ❑5.SIET:L W/COATING [19 CATHODIC PROTECTION 4" [15 STEEL W/COATING ❑95.UNKNOWN 4°5 VII.PIPING LEAK DETEMON(Cla,&.1l Oeste ly)(A dwcr 6..fine mautonna program ah.11 be mbmilkd tome weal aR ) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING neo SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SI OT ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM 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. ❑'- MONTHLY 0.2 GPH I EST ❑2. MONTHLY 0.2 GPM TEST ❑3.ANNUAL IN1EGR1'1'Y TEST(0.1 GPIs) ❑3.ANNUAL INTEGRITY TEST(OAGPH) 04 DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Checkall matapply) ❑5,DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIA.PIPING INTEGRITY TEST(0.1 GPM) ❑5. DAILY VISUAL MONITORING OF PIPING AND PUNNING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6. TRIENNIAL INTEGRITY TEST B)I GPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7. SELF MONITORING ❑9 BIENNIAL INTEGRITY TEST(0.1 GPII) GRAV TfY FLOW(Check all mat apply): ❑9. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING, PRESSURIZED PIPING(Check all that appy): PRESSURIZED PIPING(Cheek all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WE[II AUDIBLE AND VISUAL ALARMS AND(Chxk one) ALARMS AND(Check on.) ❑a. AUTO PUMP SENT OFF WHEN A LEAK OCCURS ❑. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b. ALTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑h AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ®c. NO AUT0 PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF ® 11 AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WEDI FLOW SHUT I I AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ®12 ANNUAL INTEGRITY TEST(0.1 GPH) ❑12 ANNUAL INTEGRITY TEST(0 1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [113. CONTINUOUS SOW SENSOR+AUDIBLE AND VISUAL ALARMS [113, CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) [114 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFT 4 O 14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑15 AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)W12TIOUT FLOW 015, AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION [116 ANNUAL INTEGRITY TEST(0.1 GPH) [116 ANNUAL INTEGRITY TEST(0.1 GPH) [117 DAILY VISUAL CHECK 017. DAILY VISUAL CHECK Vlll.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ® 1.FLOAT MECHANISM THATSHUTS OFF SHEAR VALVE ❑4 DAILY VISUAL CHECK DATE INSTALLED 469 ❑2.CONINUOUS DISPENSER PAN SENSOR t AW113LE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING 1999 ❑3 CONTINUOUS DISPENSER PAN SENSOR win l AUTO SI OT OFF FOR C3 6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I cutify tint the mfonpation pmwded herein u bee aM accurate tome bealof raw Immkdpe. SIG OF OWNEg�PE�ATOR DATE 479 LCJ 3 9 0 3 NAME OF OWNER/ PRATOR(Pnnt) 37.0 OF WNF.R/OPERATOR T 471 SANDY EDWARDS r l�J m LpJt Permit Number(For local..Ny) 473 Permit Approved(Port c 1 u e rmly) Pen.il Eaptranon Dala(Por lorJL u e ody) 475 UPCF(1/99 revised) Formerly SWRCB Fonn B