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Mar 19 04 11 : 24a RHL 2sign Group (925 ' x13-9709 p. 8 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check alhhatapply) Paso 7 or 7 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEMTYPE NEPRESSURE 02.SUCTION 03.GRAVITY 458 01.PRESSURE 02. SUCTION 03.GRAVITY 459 CONSTRUCTION 1.SINGLE WALL 03.LINEDTRENCH 099.OTHER 460 01.SINGLE WALL 095,UNKNOWN 462 MANUFACTURER®2.DOUBLE WALL 0 9S.UNKNOWN 0 2.DOUBLE WALL 099.OTHER MANUFACTURER WCSTCm Fiberglass 461 MANUFACTURER 463 ❑I.BARE STEEL 06.FRP COMPATIBLE W11W. Mr:THANOL 01.BARE STEEL 06.FRP COMPATIBLE W7100%METHANOL 02.STAINLESS STEEL 07.GALVANIZED STEEL 0U.,k.wn 02. STAINLESS STEEL 07 GALVANIZED STEEL 03.PLASTIC COMPATIBLE W/CONTENTS 099. 00m1 03: PLASTIC COMPATIBLE W1 CONTENTS 08.FLEXIBLE(HOPE) 099. OTHER 0 4.FIBERGLASS 0 S.FLEXIBLE(HDPE) 0 4. FIBERGLASS 0 9,CATHODIC PROTECTION 0 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATINU 0 95.UNKNOWN 463 VU.PIPING LEAK DETECTION Cheakall tmta 17 Atleseri icer oTt_IN uunnain shall M nobmlued m do lor4l enc. UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL.PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Chwk all Na apply): PRESSURIZED PIPING(Chak all Jot apply): 0 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT 0 1. ELECTRONIC I.INF.LEAK DETECTOR 3.0 GPII 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. 02.MONTHLY 0.2 OPH TEST 02. MONT14LY 0.2 GPM TEST 0 3.ANNUAL INTEGRITY TEST(0.1GPH) 0 3.ANNUAL INTEGRITY TEST(O.IGPH) 0 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVEN'HONAL SUCTION SYSTEMS(Clerk all tart apply) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM r'TRIENNIAL PIPING 0 S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPINU): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPM) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 1:17. SELF MONRORING 0 9.BIENNIAL INTEGRITY TEST(0.1 GPM) GRAVITY FLOW(Chak all Ihdl.pplyy. S. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.I OPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all tart apply): PRESSI IRIZED PIPING(Cheek all thra nPply) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTMUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Q Doer) ALA RMS AND(Cheek-) D.. 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 OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION 0c. NO AUTO PUMP SHUT OFF ❑c NO AUTO PUMP SHUT OFF 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLAW SHUT El H. AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION 012. ANNUAL INTEGRITY TEST Mi.1 GPM) 012. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION)GRAVITY SYSTEM SUCTION)GRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR*AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMPSENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(C'heak all that apply) EMERGENCY GENERATORS ONLY(Check all iia apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• 014. CONTINUOUS SUMP SENSOR WITHOI a AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS E1 15. AU'1'OMA'l'IC LINE LEAK DETECTOR(3.0 UPM TES O W 1I HOUT FLOW 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) SHUT OFF OR RESTRICTION 16.ANNUAL INTEGRITY TEST(0.1 GPM) 0 l0.ANNUAL INTEGRITY TEST(0.1 GPM) ❑17. DAILY VISUAL CHECK [117. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT _ DISPENSER CONTAINMENT 01.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04.DAILY VISUAL CHECK DATE INSTALLED 469 02.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER/MONRORMG 2004 ®3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I wtiry Jou do govided 1-6n e.M accurate,.VrcL.rmy knwledga. SIGNA 0 OV1E ERATO DATE 470 N EOF OWNER/OPRATOR(priul) al TITLE FOWNER/OPERA 'R 4T- SAFE WAY,INC. REAL E STATE MANAGER-FUEL CENTERS Pvmit Naalcr(For tical me only) 4i Permit Appro®d(For bail me only) 474 P.ft Epiraiea Daae(Far tical.only) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form B