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Ak CMMD PROGRAM CONSOUBATED FOWA TANK UNDERGROUND STORAGE TANKS -TANK PAGE 2 VL PIPING CONSTRUCTION suffistapply) Pap-of- UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 458 [3 1.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 coNsmucnm []1.SINGLE WALL 0 3.LE-MD TRENCH 0 99.OTHER 460 0 1.SINGLE WALL 0 95.UNKNOWN 462 MANUFACTURER E3 2.DOUBLE WALL 0 95.UNKNOWN 13 2.DOUBLE WALL [3 99.OTHER MANUFACTURER Ameron 461 MANUFACTURER 463 [3 1.BARE STEEL 0 6.FRP COMPATIBLE w/100 METHANOL [I I-BARE STEEL 0 6.FRP COMPATIBLE WAN%METHANOL 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 10 unkii-wa 13 2. STAINLESS STEEL 13 7.GALVANIZED STEEL 0 3.PLASTIC COMPATIBLE W/CONTENTS [199. Other 0 3. PLASTIC COMPATIBLE W/CONTENTS 0 s.FLEXIBLE(HDPE) 0 99. OTHER 19 4.FIBERGLASS 13 S.FLEXURE(HDPE) 13 4. FIBERGLASS El 9.CATHODIC PROTECTION 13 5.STEEL W/COATINQ 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING 0 95.UNKNOWN 465 VII.PIPING LEAK DETECTION(ch.&.0 that apply)(A oftherponitoring propart:sball bemalmmitted to 1heIocml!Enff2 UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 40 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Chock all that apply): [3 1.ELECTRONIC LINE LEAK DETECTOR 10 GPH TEST WITTI AUTO PUMP SHUT ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 cpuTEsT 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. [12.MONTHLY 0.2 GPH TEST 2.MONTHLY 0.2 G1PH MT 0 3.ANNUAL Immmrry TEST(o.icpM 0 3.ANNUAL INTEGRITY TEST(O.IGPII) 0 4, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEM(Check all that apply) [3 5.DAILY VISUAL momromo OF PUMPING SYSTEM+TRIENNIAL PIPING 0 3. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM RMGRrffTEST(0.I CPR) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING)-. E3 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING: GRAVITY FLOW p7. SELF momroRiNo Ij 9.BIENNIAL INTEGRITY TEST(0.1 GPM GRAVrrY FLOW(Check all that apply): 8. DAILY VISUAL MONITORING ❑9. BIENNIAL DrIEGRM TEST(0.1 GM SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check one) ALARMS AND(Chock one) El a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b. AUTO PUMP sHLrr OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION no. NO AUTO PUMP SHUT OFF pc NO AUTO PUMP SHUT OFF C9 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHFLOW SHUT 13 11. AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION [3 12.ANNUAL INTEGRITY MST(0-1 GPM [3 12. ANNUAL INTEGRrry TEST(m GFH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [3 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 0 15. AuromATTc LINE LEAK DETECTOR(3.0 GPH TEST)wrrHouT FLOW 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION [3 16.ANNUAL MMGRfrY TEST(0.1 GPH) 0 16.ANNUAL IN mmrry TEST(u GPn) 0 17.DAILY VISUAL CHECK 0 17.DAILY VISUAL CHECK VIII.DISPENSER CONTAINMZNT DISPENSER CONTAINMENT 13 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4.DAILY VISUAL CHECK DATE INSTALLED 468 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [3 5.TRENCH LINER/MONITORING Unk 0 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR p 6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS UL OWNERIOPERATOR SIGNATURE I off*that the ikformation provided ham is true and accurate to the best ofmy knowledge. SIGMA OWNER/OPE R DATE 470 11/4/03 NAME NAAM OF OWNERIOPLATOR.(print) I= OF OWNER/OPERATOR 472 (7Dy Agent for Owner Pamt Number(For local use only) 473 Parrot Approved(For local use only) Permit Expiration Date(For local use only) 475