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NIFIED PROGRAM CONSOLIDATED FOR TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION (Check as thal apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1 PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑ 99. OTHER E�.�l( 1. SINGLE WALL ❑ 95. UNKNOWN CONSTRUCTION/ MANUFACTURER 2. DOUBLE WALL 4�� UNKNJaWN� X2. DOUBLE WALL e!a 9. OTHER �j'� O �� G MANUFACTURER �m.`Y�1 •��'h'C'\�Z� MANUFACTURER V 1 4,�5� ❑ 1. BARE STEEL ❑ 0. FRP COMPATIBLE W/ 100% METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE W/ 100% MET MATERIALS AND 112. STAINLESS STEEL' ❑ -7. GALVANIZED STEEL 112. STAINLESS STEEL 117. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 95, UNKNOWN 113. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXIBLE (HOPE) - 119: O ❑ 4. FIBERGLASS ❑ B. FLEXIBLE (HDPE) ❑ 99. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ` ��\ A5. STEEL W/ COATING ❑ 9. CATHODIC PROTECTION S. STEEL W/ COATING ❑ 95. UNKNOWN VII. PIPING LEAK DETECTION (Check ad that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING (Check as that apply): PRESSURIZED PIPING (Check all that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION • AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNECTION AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPH TEST ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check all that apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM • TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST (0.1 GPH) ❑ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all that apply): ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check aN that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (check one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 19 b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM Xb AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION El c. NO AUTO PUMP SHUT OFF 11c. NO AUTO PUMP SHUT OFF �� 04. 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR 16 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) (X12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR - AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check as that apply) EMERGENCY GENERATORS ONLY (Check as that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF - AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 18. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DAT INS ALLED 2. CONTINUOUS DISPENSER PAN SENSOR • AUDIBLE AND VISUAL ALARMS 115. TRENCH LINER/ MONITORING ryp❑ ya 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS ❑ 0. NONE IX. OWNER/OPERATOR SIGNATURE 1 certify that the information provided herein is true and a to the best of my knowledge. SIGNATURE OF OWNER/OPERATOR,,---6 ma� DATE i, /1 r /01 NAME OF OWNER/OPERATOR (prfnf) ; Q� ON -A TITLE OF OWNERrOPERATOR ) �� i Permit Number (For local use only) I Permit Approved (For local use only) I Permit Expiration Date (For local use only) CUPAFORM (4/99) 0 0 Formerly SWRCB Form 8