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Mar 19 04 11 : 23a RHL Psign Group (925 ' "113-9709 p. 6 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(CherFvngw 1) Poet 3of7 UNDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE 10 1.PRESSURE 0 2,SUCTION 0 3.GRAVITY 4U ❑I.PRESSURE 0 2. SUCTION 0 3.GRAVITY 419 CONSTRUCTION 0 I.SINGLE WALL 0 3.LINED FRENCH [199.OTHER 460 0 1.SINGLE WALL 0 95.UNKNOWN 462 MANUFACTURER®2.DOUBLE WALL 095.INKNOWN 02.DOUBLE WALL 099.OTHER MANUFACTURER Weerem F1beI 1a56 461 MANUFACTURER 463 ❑I.BARE STEEL ❑6.FRP COMPATIBLE W/[M% METHANOLrO BARE STEEL ❑6.FRP COMPATIBLE wn0W.METIAN0L 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UnknownSTAINLESS STEEL 0 7.GALVANIZED STEEL 03 PLASTIC COMPATIRTE.. W/CONTENTS 099. OILecPLASTIC COMPATIBLE W/CONTENTS O 0.FLEXIBLE(HOPE) 099. 017HER 04.FIBERGLASS 08.FLEXIBLE(HDPE) FIBERGLASS 09.CATHODIC PROTECTION 0S.STEELW/COATING 09.CATHODIC PROTECTION 46451 EEL WICOM'NO 095.UNKNOWN 40s VII.PIPING LEAKDETECfION(Cheekalltlwa )(A ptiaocifthmasnatiftningmr,,rainshall ba subminol to me oral vgrnry UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Cheek all that apply) PRESSURIZED PIPING(Ch,&ttil dwt vpyly): 0 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT 0 1, ELECTRONIC LING LEAK DETECTOR 3.0 GPM TEST W I_I'H AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUTOFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISOON NECTION+ AUDI RLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. 0 2.MONTHLY 0.2 GPM TEST [12. MONTHLY 0.2 GPM TEST [13.ANNUAL INTEGRITY TEST(O.IGP14) 0 3.ANNUAL INTEGRITY TEST(O.IGPR) 04. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chuck all chat apply) 05.DAILY VISUAL MONI I CHING OF PUMPING SYSTEM TRIENNIAL PIPING 05. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPNG): 0 5. TRIENNIAL INTEGRITY TEST(0.1 GPH) 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELF MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.1 GPM) GRAVITY FLOW([beak all thar apply)' ❑S. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check a110wt apply) PRF9.91 IRIZF.n PIPING(Trak all that apnir) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE.SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Clerk ane) ALARMS AND it ora) 0.. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ®b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT Orr FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Gc. NO AUTO PUMP SHUT OFF 0. NO AUTO PUMP SHUT OFF 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT 0 IL AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION 0 12. ANNUAL INTEGRITY TEST(0.1 GPM) 0 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION/GRAVITY SYSTEM SUCTIONIGRAVTTYSYSTEM 013. CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE ANDVLSUALALARMS EMERGENCY GENERATORS ONLY(Clack all dw apply) EMERGENCY GENERATORS ONLY(Chsk all 6.apply) 014. CONTINUOUS SUMP SENSOR WITHO AUTO PUMPSHUTOFF' 014. CONTINUOUS SUMP SENSOR WITMOCT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW GIS. AUTOMATIC LINELEAK DETECTOR(3.0GPH TEST) SHUT OFF OR RESTRICTION 0 16.ANNUAL INTEGRITY TEST(O.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPM) 017. DAILY VISUAL CHECK 017. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT Cl 1.FLUAT MECHANISM THAI SHUTS OFF SHEAR VALVE 04.DAILY VISUAL CHECK DATE INSTALLED 46R [12.CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS 0 5.TRENCH LINER/MONITORNG 2004 193.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS UL OWNER/OPERATOR SIGNATURE I certify dwt the ldornabn wartded he.elt is into mW auumm to die len of my bmwbdge. SIGNATOR OF 1VNf.R/O OR DATE. , 470 NAME OF OWNEWOPRA1111i 471 TITLE OF OWNER/OPE TOR 472 SAFEWAY,INC. OIREAL ESTATE MANAGER -FUEL CENTERS Permit Number(Fw local uu only) 4103A610.1iAppmvad(For(wal an,only) 474 Permit Eaphatian Da¢(Fw local use only) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form B