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4 TRUM PROGRAM CONSOLIDATED FO TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 2 of VI. CONMUCTION(i atcau"sow Pam UNDMOROUND PIPING ABOVFMOUND PIPING SYSTEM TYPE M I.PRESSURE ❑2.SUCTION ❑3.GRAVITY 45a ❑1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 45A CONSTRUCTIOM ❑1.SINGLE WALL ❑3.LIFTED TRENCH ❑99.OTHER 469. [❑1.SINGLE WALL ❑95.UNKNOWN 462 MANUFACTURER Ea2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461. MANUFACTURER 463. ❑1.BARB STEEL 1%6.FRP COMPATIBLE W/100%METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE WA OD%METHANOL ❑Z STAINLESS STEEL ❑7.GALVANIZED STEEL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE WITH CONTENTS ❑95.UNKNOWN ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPB) ❑99.OTHER ❑4.FIBERGLASS ❑S.FLEXIBLE(HDPE) ❑99 OTHER ❑4.FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEM W/COATING ❑9.CATHODIC PROTECTION 464. ❑5.STEEL.W/coxnNG ❑95.UNKNOWN 465. VII.MING LEAK DETECTION C3xkgodest ofthe won to todwIne t UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WAIL PIPING 467• PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPVW(Check all that apply): ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST WITH AUTO PUMP (31. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT-OFF FOR LBAK,SYSTEM FAILURE AND 3YSTER!DISCONNECTION SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS ❑2. MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GFH TEST ❑3. .ANNUAL INTEGRITY TEST(0.1 OPH) [33. ANNUAL INTEGRITY TEST(0.1 OPH) [34. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTIONS (Cheek all that apply) ❑5. DALLY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) ❑S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 136. TRIENNIAL INTEGRITY TEST(al GPIO 137. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7. SELF MONITORING 139. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): ❑S. DAILY VISUAL MONITORING 9 BEIRMIAL INTEGRITY TEST(0.1 GPH) SECONDAMY CONTAINED PIMG SECONDAMLY CONTAINED FIMG PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10. 0ONTINUOUS TURBINE SUMP SENSOR 1V1TIi AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check am) ALARMS AND(Clerk ate) ❑a. AUTO PUMP SHUT OFF Vmw A LEAK OCCURS ❑a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS IN b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNBCTION ❑c. NO AUTO PUMP SHUT OFF (3c. NO AUTO PUMP SHUT OFF ❑11. AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST)WITH FLOW MITT OFF OR RESTRICTION E311.AUTOMATIC LEAK DETECTOR ❑11 ANNUAL INTEGRITY TEST(0.1 GPH) ❑12 ANNUAL INTEGRITY TEST(0.1 OPH) SUCTION/GRAVITY SYSTEM SUCTIONGRAVTTY SYSTEM ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all fbat apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF ❑14.CONTINUOUS SUMP SENSOR WITHOJU AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 1315 AUTOMATIC LINE LEAK DETECTOR (3.0 OPH TEST) O Thi FLOW ❑15.AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST) SHUT OFF OR RESTRICTION ❑16. ANNUAL INTEGRITY TEST(0.1 GFH) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑17. DAILY VISUAL CHECK ❑17.DAILY VISUAL CHECK VIII DISMSER CONTAINNFAT DISPENSM CONTAINMENT 468. ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4. DAILY VISUAL CHECK 469. DATE INSTALLED ❑2. CONTINUOUS DIM04SER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5. TRENCH/LINSR MONITORING ry O 1&3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6. NONE ®C DISPENSER+AUDIBLE AND VISUAL ALARMS EL OWNER/OPERATOR SIGNATURE I ceRify that the information provided herein is true and acourate to the beat of my Imowledga GNATURE F O PERA R DATE: 470. NAME OF OWNER/OPERATOR(priMr IC1 N A' L- . /s?1/IICj(d TITLE OF OWNER/OPERATOR: ®w nl G7R 472 Permit Number(Agency use only) 473 1 Pmt Approved By(Agency use only) 474 T Permit Expushon Date(Agency use only) 475. UPCF (1/91!)-Y4 bttp://-w. erg Rev.QW6100