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FROM : J. Schetter PHONE NO. : 5306667692 Dec. 02 2085 02:48PM P8 UL. FIFD PROGRAM CONSOLIDATFU FORM _ TANKS J14 UNDERGROUND STORAGE TANKS - TANK PAGE 2 Pa gc 2 of 2 VI.PIPING CONSTRICTION(Check all that a 1 ) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE ❑2,SUCTION ❑3.GRAVITY 455. Q t,PRESSURE ❑2.SUC'l']QN 0 3.GRAVITY 459. CONSTRUCTION/ MANTI F'ACTl1RER C]1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 460. ❑1.SINGLE WALL Q 95.UNKNOWN 462 ®2.L OUFtLF,WALL ❑95.UNKNOWN ❑2.DOIJBI,>.WAIL ❑99.OTHER MANUFACTURER A_O. Smith 461. MANUFACTURER 463. ❑1,RARE STEEL, 116,FRP COMPATIOLP W/100%METHANOL q 1.BARE STEEL ❑6.F121'COMPATIBLE W/10036 METHANOL [12,STAINLESS STEEL Q 7,GALVANIZED STLPI. ❑2.STAINLESS STEEL ❑7.GALVANIZED S'I*EEL ❑3.PLASTIC COMPATIBLE WITH CONTENTS ❑95.UNKNOWN ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPE.) ❑99.OTI1r;R ®4.F113F..RGLASS ❑8.FI:FXIBLE(HDPE) ❑99.OTHER [14.FIBERGLASS ❑9.CATtIOnIC PROTECTION Q 5,STEEL W/COATING 1:19.CATHODIC PROTECTION 464. ❑5.STEEL W/COATING ❑95.UNKNOWN 465. VII.PIPING LEAK DETECFION t'Mtk:11 that apply)(A dacri ion of the iaoaitoeiisg pcoyTam shall be wbmittea to ttu heal e UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 460. SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that.apply): PRESSURIZED PIPING(Check all that apply); {]1. ELECTRONIC LINT? LEAK DETECTOR 3.0 GPI( rtES L WIT AUTO PUMP ❑1. r1,r,CTRONIC LINE LEAK D$1'EC'1'OR 3.0 OPH Tr.,.->T WITI l AUTO PUMP SIIUT-OFF FOR LEAK,SYSTICM FAILURE,AND SYSTEM DISCONNECTION SH(ST Or'r FOR 1.r•,AK,SYSTEM FAILURE,AND SYSTEM DISC;ONNEC:ION +AIIDIIII.,G AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. E12. MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST ❑3. ANNUAL INTr•_GRITY TEST(0.1 GPH) ❑3. ANNUAL IN'I'LK.RI'rY TEST(03 GPH) i]4, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVFNTIONAI,SUCTION SYST'>MS(Chuck all that apply) ❑5. DAILY VISUAL,MONITORING OF PUMPING SYSTEM+TRE24NIAL PIPING INTEGRITY TEST(0.1 GPH) ❑5. DAILY VISUAL MONITORING OF PIP1NCl AND PUMMN(y SYS'T'LM SAFE SUCTION SYSTEMS(NO VALVES IN 13GLOW GROUND PIPING): ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑7. SFI.F MONITORING SAPEr SUCTION SYSTEMS(NO VAi,VI g IN 14HL.OW GROUND PIPING): GRAVITY FLOW ❑7. SELF MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(CImck all that apply): ❑8. DAILY VISUAL MONITORING➢ EJ 9, BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINF,D PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply)! 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SOMI' SENSOR WITH AUDIBLE AND VISUAL. Ai.AFWS AND(Check one) ALARMS AND(Check cme) ❑a. AUTO P1 IMP SKUT OFF WHEN A LEAK OCCURS Q a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ®b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b. AUTO PUMP SHU'r OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISC 'NNF,CTION DISCONNFCIION ❑�. NO AUTO PUMP SHUT•OFF ❑c. NO AUTO PUMP SHUT Orr ®11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT ❑11. AiITOMATTC LEAK DETECTOR OFF OR RESTRICTION ❑t.2. ANNUAL INTEGRITY TF..ST(0,1 GPH) ❑12. ANNUAL INT'FGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUC IONIGRAVITY SYSTEM [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS [113. CONTINUOUS SUMP SENSOR+AUDIRI.F.. AND VISUAL.ALARMS EMERGENCY GENERATORS ONLY(Check 311 that apply) EMERGENCY GENERATORS ONLY(Chock all that apply) ❑14. CONTINUOUS SUMP SENSOR WfTH0 C AUTO PUMP SHIT OFF ❑14, CONTINUOUS SUMP SENSOR WI�1 T AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARM$ AUDIBLEAND VISUAL ALARMS ❑15. AUTOMATIC LINE LEAK DETECTOR (3.0 Gp11 -1'tiST) WITHOUT FLOW Q 15. AUTOMATIC LINE LEAK D IECTOR(3.0 GFH'1'6S'i) SHUT OFF OR RESTRICTION [116. ANNI)AI,rNTr•,GRLTY TEST(0.1 GPH) ❑16, ANNUAL INTEGRITY TEST(0.t.GPH) ❑17. DAILY VISUAL ClIrCK Q 17, DAILY VISUAL CHECK VITT.DISPENSER(:ONTAINNI,ENT DISPENSER CONTAINMENT 468. Eli, FLOAT MECHANTSMTHAT SHUTS OFF SHEAR VALVE F-14. DAILY VNUAL CHECK 00, DATE INSTALL.EI) ❑2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5. TRENCH/LINER MONITORING 1999 03. CONTINUOUS DISPFNSER PAN SENSOR WITR AUTO SHUT OFF FOR [16. NONE DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I ce-dify 64 th information provided herein is tnte and accurate to the best of my knowledge. SIGNATUREo o OPERA DATE:10/12/04 370 NAMF OF O .R/OPERATOR(pr;r,i): John Schetter TITLE OF OWNEWOPFRATOR, COmpllanec Specialist 472. Permit Number(Agency use on)y) 473. 1 Perwil Approved By(Almixy LLw only) 474. 1 Permit expiration Date(Agency use only) 475.