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FROM (THU) JUN 10 2004 12 ' IST, 12 ;27/No, 6807953510 P 5 UN WIS PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 2 VI.PIPING CONSTRUCTION Chi dl thr UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE TLPRESSURE ❑2.SUCTION [13,GRAVITY 4M [11.PRESSURE 0 2. SUCTION C)3.GRAVITY UY CONSTRUCTION �❑11 SINGLE WALL L)3.LINED TRF5ICH Q 99.CM"FR 460 Q 1.SINGLE.WALL, El 95.UNKNOWN 463 MANUFACTURER( DOUBLE,WALL O 95.UNKNOWN (:12-DOUBLE WALL ❑99.OTHER MANUFACTURER 14'�Mt: '1� 461 MANUFAf.TURBR 46S ❑L BARE STEEL ❑6.PRP COMPATIBLE,-/100% METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE W/[00%MIT14AN0L ❑2.STAINLESS STPFI, O 7,GALVANIZED STEEL ❑UW. ❑2. STAINLESS STEEL ❑7.GALVANIZED STEEL V10 PLASTIC COMPATIBLE W/CONTENTS L]77.OdKf (33. PLASTIC COMPATIBLE W/CONTENTS Q S.FLEMBLE(HDPE) C399. OTHER I P15F;ROLA93 ❑(I.FLEXIBLE(HDPE) ❑4. FIBERGLASS Q 9,CATI IODIC PROTECTION O 5 STEEL,W/CGATrNG ❑9.CATHODIC PROTECTION 404 ❑5, STEEL W(COATTNG ❑95,UNKNOWN 465 VIL PIPING LEAK DETECTION CEwtk a qtr A or 44 awhWag pmWm wwl be w"wrke4 o dr kw3g UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 4m SINGLE WALT,PIPING 467 PRESSURIZED PIPING(Cbeckall do apply): PRESSURIZED PIPING((berk0"Apply): ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITlI AUTO PUMP SFRIT 0i PI.PI'IRONEC E.rNP.T.P.AK DP.TE(-TOR 3.0(IPEI TE.RT W):')ZI AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUTOFF FORLEAK,SYSTEM FAIAMR,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS, AUDIBLE AND VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH TEST ❑2 MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.IGPH) ❑3.ANNUAL INTEGRITY TEST(0.IGPH) O 4. DAILY VISUAL CHECK (:ONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all Ewmpply) ❑5,DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING Q 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0,1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW OROUNDPIPLNG): ❑6, TRIENNIAL INTEGRITY TEST(o.I ripm) ❑7,SF,I,P MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLAW 07. SELF MONITORING O 9,BIENNIAL INTEGRITY TEST(0.1 GPH) ORAVITY FLAW(Check all mRply): ❑S, DAILY VISUAL MONITORING C39, BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CANTArNrn PIPTNG SECONDARILY CONTAINED PEPQVG PRESSURIZED PIPING(Choc J"wly} PRESSURIZED PIPING(Chock JI dnmh*)f 10. CONTINUOUS TLIRRINP 3I.1MP SENSOR WITH AUDIBLE AND VISUAL I0.CONTINUOUS TURBINE SUMP SENSOR W<'N AUD(13LF.AND VI$VAL ALARMS AND(Cheek oee) ALARMS AND(Check me) ❑/� AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b. AUTO PUMP SHUT OFF FOR L.IiAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SY5TENt FAILURE AND SYSTEM DISCONNECTION DISCONNECTION QG, NO AVTO PUMP SHUT OFF 0NO AUTO PUMP SHUT OFF ❑11. AUTOMATIC LIMP, LEAK DETECTOR(3.0 OPH TEST)WWII FLOW SHUT ❑11. AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANN(JAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/ORAVITY SYSTEM []11. CON7FNUOUS SUMP SENSOR.AUDIA1.9 AND VTSI.IAt.AIARMS [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Checkell tlw apply) ❑l4. cONTrNUDUS SUMP SENSOR WITHOUT AUTO PUMP SM)T OFF• ©m CONTINUOUS SUMP SENSOR WITIiO AUTO PUMP SHUT OFF r AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS Q 15. AUTOMATIC LINE LEAK DETECTOR(3,0 GPH TEST),Yl:lTlK&U FLOW [315. AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST) St IVT OFF OR RESTRICTION ❑16.ANNUM,INYF.GRITV TP-%T(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0.1 OP11) ©17. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VUL DISPENSER CONTAINMENT DISPE,NSF.R CONTAINMENT ❑1.FLOAT MP,CHANESM TIIAT SHUTS OFF SHEAR VALVE ❑4,DAILY VISUAL CIIE.CK DATE INSTALLED 4W ❑ NTINUOUS DISPENSER PAN SENSOK+AUDIBLE AND VISUAL ALARMS Q 5.TRENCH LINER/MONITORING 3,CONTINUOUS DISPENSER PAN SENSOR=AUTO StEUI'OFF FOR ❑6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNERIOPERATOR SIGNATURE I kxrofy and tomb to be beet of aro kmwWo. ATU DATE � 470 14AM'OF O"ER11JP TOR ) 471 TI F OWN PERATOR 472 _ i Peraeit miker(Fw local qtly) 173 P4mtit Appaoved(Par kxd aeae mly) 474 UPm=t as Date(For local we only) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form B