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MUTED PROGRAM CONSOLIDATED FO <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION Chink all that apply) Page 5 of 7 <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE M 1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 458 [11.PRESSURE C 2. SUCTION D 3.GRAVITY 459 <br /> CONSTRUCTION C 1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 0 1.SINGLE WALL C 95.UNKNOWN 462 <br /> MANUFACTURER 0 2.DOUBLE WALL C 95.UNKNOWN 0 2.DOUBLE WALL C 99.OTHER <br /> MANUFACTURER Westem Fiberglass 461 MANUFACTURER 463 <br /> ❑ 1.BARE STEEL C 6.FRP COMPATIBLE w/im hIETHANOL C 1.BARE STEEL [16.FRP COMPATIBLE W/100%METw 01- <br /> 0 2.STAINLESS STEEL D 7.GALVANIZED.STEEL 0 Unknown 0 2. STAINLESS STEEL [17.GALVANIZED STEEL <br /> [13.PLASTIC COMPATIBLE W/CONTENTS [199, GUM [13. PLASTIC COMPATIBLE W/CONTENTS D S.FLEXIBLE(HOPE) C 99. OTHER <br /> 0 4.FIBERGLASS N 8.FLEXIBLE(HDPE) [14. FIBERGLASS D 9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING [19.CATHODIC PROTECTION 464 0 5. STEEL W/COATING [195.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION(Check all ft capty)(A cription ofthe mattoring progrant shall be submitted to the kxel agency.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 0 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT C 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO 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 /> 0 2.MONT14LY 0.2 GPH TEST C 2. MONTHLY 0.2 GPH TEST <br /> 0 3.ANNUAL INTEGRITY TEST(O.1GPH) [13.ANNUAL INTEGRITY TEST(0.1GPM <br /> 0 4. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> ❑ <br /> S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING D 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPM <br /> [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELF MONITORING <br /> [19.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): <br /> 0 8. DAILY VISUAL MONITORING <br /> C 9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WIT <br /> ITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Check ono) <br /> 0a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS C a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> ®It. 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 /> 0c. NO AUTO PUMP SHUT OFF 0c NO AUTO PUMP SHUT OFF <br /> 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 0 11 AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY 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(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> [114. CONTINUOUS SUMP SENSOR WITH AUTO PUMP SHUT OFF 4 0 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 GPH TEST)WITHOUT FLOW D 15. AUTOMATIC LIVE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> C 16.ANNUAL INTEGRITY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑17. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK <br /> DATE INSTALLED 469 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING <br /> 2003 ®3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR D 6.NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> UL OWNER/OPERATOR SIGNATURE <br /> 1 certify that the information provided herein b we and accurate to the best of my knowledge. <br /> SICNA OF OWNE PEAAT R DATEty 470 <br /> NAME OF OWNER/O RATOR(prmt) 471 1 TITLE OF OWNER/OPERATOR 471 <br /> SAFEWAY,INC. O&UWAREAL ESTATE MANAGER-FUEL CENTERS <br /> P7 Number(F-I.Wuw only) 473 Permit Approved(For knot ave only) 474 Permit Expiration Date(For foW use only) 475 <br /> UPCF(12/99 revised) 12 Formerly SWRCB Form B <br />