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I'll <br /> DIED PROGRAM CONSOLIDATED FOk./ <br /> 1. TANK <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION Chcck.E Ih.t.rpy2 Pana of <br /> UNDERGROUND PIPING A13OVEGROUND PIPING <br /> SYSTEM TYPE ® I.PRESSURE D 2.SUCTION D 3.GRAVITY n.SR D I.PRESSURE D 2. SUCTION D 3.GRAVITY 49t <br /> CONSMUCTTON D 1.SINGLE WALL [13 LINEDIRENCH D 99,OTHER 4d0 D 1.SINGLE WALT. D 95.UNKNOWN net <br /> MANUFAC BAER ®2.DOABLE:WALL 1-195 (UNKNOWN D 2,DOUBLE WALL. 0 p, O•i'TLEE <br /> MANUFACTURER nnl MANUFACTURER 463 <br /> D 1.BARE S'ruu. D 6.FRP COMPATIBLE w/10W.. METHANOL D I.BARE STEEL ❑6.FRP COMPATIBLE W/I0014,METHANOL <br /> D 2.STAINLESS S'IEEL D 7.GALVANIZED STEEL. I D Unknown [12 STAINLESS STEEL [17 GALVANIZED S"FEEL <br /> D 3.PLASTIC COMPA'T'IBLE W/CONTENTS D 99. Other D 3. PLASTIC COMPATIBLE W/CONTENTS D S.FLEXIBLE(HDPE:) D 99. OTHER <br /> ®4.FIBERGLASS D S.FLEXIBLE GIDPE) D 4. FIBERGLASS D 9.CATHODIC PROTECTION <br /> D 5 S'I'IiliL W/COATING D 9 CATHODIC.PROTECTION 464 D 5, S'IEEI.W/COATING D 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECI•ION(Chmkall that apply)(A Ia-.Ph.a.f the mnrtilprulR proprva ahall be aubndJed he It.luead .,.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING ndfi SINGLE WALL PIPING 407 <br /> PRESSURIZED PIPING(Check all that apply) PRESSURIZED PIPING(Check.11 that apply): <br /> D 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SNIT D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AITTO PUMP <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> D 2.MONTHLY 0.2 GPH TEST [12 MONTHLY 0.2 GPH TEST <br /> 03 ANNUAL INTEGRITY TEST(l1.IGPH) D 3.ANNUAL INTEGRITY TEST(0,IGPH) <br /> [14 DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> D 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING <br /> INTEGRITY TEST(0.1 GPH) 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPMG): Cl 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> D 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' <br /> GRAVITY FLOW D 7. SELF MONITORING <br /> D9 BIENNIAL INTEGRITYTEST B.1 GPH) GRAVITY FLOW(Check all that apply). <br /> D R. DAILY VISUAL MONITORING <br /> D 9. BIENNIAL INTEGRITY TEST(0.1 GPI 1) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check W that apply) PRESSURIZED PIPING(Check all that apply): <br /> N CONITINUOUS TIURBME SUMP SENSOR WIT14 AUDIBLE AND VISUAL 10 CONTINU(IIIS TURBINE STUMP SENSOR WIT7,1 AUDIBLE AND VISUAL <br /> ALARMS AND(Check mu) ALARMS AND(Check mu) <br /> 0. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS D a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> Ob AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> ®c. NO AUTO PUMP SMUT OFF Oc NO AUTO PUMP SMUT OFF <br /> 19 11 AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WI•I'H FLOW SHUT <br /> OFF OR RESTRICTION D I1. AUTOMATIC LEAK DETECTOR <br /> ®12. ANNUAL INTEGRITY TEST(0,I GPH) D 12 ANNUAL INTEGRITY TEST(0 1 GPH) <br /> STICTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> D 13, CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS D 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all tial apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> [114 CONTINUOUS SUMP SENSOR WIT IG AUfO PUMP SHUT OFF D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+ <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> [115 AUTOMATIC LINE LEAK DETECTOR(3.0 GPI(TEST)WI TOUT FLOW 015, AUTOMATIC LINE LEAK DETECTOR(3.11(iPtl TEST <br /> SHUT OFF OR RESTRICTION ) <br /> [116 ANNUAL INTEGRITY TEST(0.1 GPH) D 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> [111, DAILY VISUAL CHECK D 17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT ® LFLOATMECIIANISM THAT SHUTS OFF SHEAR VALVE D 4.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 D 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS D 5.TRENCH LINER/MONITORING <br /> 1999 D 3.CONTINUOUS DISPENSER PAN SENSOR WITH ALTO SHUT OFF FOR D 6,NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> I ranlfy that the Inmmr.Jon provided herrn awe and acamme to the neat ormy knowledge. <br /> SIG :OFWNER/QPS6I(ATOR DA T"5 I 4M <br /> cil-I(VI <br /> NAME OF OWNER/0 RATOR(print) TLE OF OWNER/OPERATOR I 4]2 <br /> SANDY DWARDS <br /> Parrett Numbcr(I.local me only) 473 Ponat APpoocil(Fm local nae only) Permit Fxphallen theta(For 1.0 uaa aply) 4]5 <br /> UPCF(1/99 revised) Fonnerly SWRCB Form B <br />