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D PROGRAM CONSOLIDATED 72M <br /> PRO <br /> TANK <br /> Tj <br /> D <br /> STORAGE TANKS- TANK PAGE 2 <br /> �111 E <br /> VL PIPING CONSTRUCTION(C) an that apply) Page-of- <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 0 1.PRESSURE 0 2.SUCTION 0 3.(3RAvrry 45s Q I.PRESSURE Q 2. suciToN ❑3.GRAVITY 459 <br /> ---- <br /> CONSTRUCTION 0 1.SINGLE WALL 0 3.LINED TRENCH 0".OTHER 460 1.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER 0 2.DOUBLE WALL 0 95.UNKNOWN Q 2.DOUBLE WALL [199.OTHER <br /> MANUFACTURER jLnknown 461 MANUFACTURER 463_ <br /> 0 1.BARE STEEL 0 6.FRP COMPATIBLE W/100% METHANOL 111-BARE STEEL Q 6.FRP COMPATIBLE W110W.METHANOL <br /> []2.STAINLESS STEEL [17.GALVANIZED STEEL 10 Unknown E3 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> [3 3.PLASTIC COMPATIBLE W/CONTENTS 0 99, other 0 3. PLASTIC COMPATIBLE W/CONTENTS 13 9-FLEXIBLE(HDPE) 0 99- OTHER <br /> 0 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) 13 4. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 4654 ' 0 5. STEEL W/CCIATING 0 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION(check all that apply)(A ofthemonitonngprogmmshall bosubmitted tothe lowlagm(,y.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all the apply): <br /> ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST IV 'H AUTO Pump SHUT 0 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPHTEST WITH AUTO PUMP <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> 2.MONTHLY 0.2 GPHTEST ❑2. MONTHLY 02 GPHTEST <br /> 0 3.ANNUAL INTEGRITY TEST(o.iGpM 0 3.ANNUAL INTEGRITY TEST(0.IGPH) <br /> [14. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> ❑5.DAILY VISUAL moNrroRjNG OF PUMPING.SYSTEM+TRIENNIAL PIPING 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 am <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW MLOUNDPIPING)t ❑6.TRIENNIAL Iz-TrEmm TEST(u GPH) <br /> 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 0 7. SELF MONITORING <br /> 0 9.BIENNIAL INTEGRITY TEST(0.1 GPM GRAVITY FLOW(Checkall that apply): <br /> 0 s.DAILY VISUAL MONITORING <br /> 0 9. BIENNIAL INTEGRITY TEST(0.I GPM <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUP"SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Check om) <br /> 0 a. AUTO PITA&SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> []b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM El b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> ol 1. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ROW SHUT 0 11. AUTOMATIC LEAK DEI'ECTOR. <br /> OFF OR RESTRICTION <br /> 0 12. ANNUAL INTEGRITY TEST(0-1 GPM 0 12. ANNUAL DrmGRrry TEST(o.i GPM <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> ❑14. CONTINUOUS suMp SENSOR wrmouT AUTO PUMP SHUT OFF• 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPHTEST)WITIIOUTFLOW 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPHTEST) <br /> SHUT OFF OR RESTRICTION <br /> [116,ANNUAL INTEGRITY TEST(o.i GPM 16.ANNUAL INTEGRITY TEST(0.1 GPM <br /> 0 17.DAILY VISUAL CHECK 0 17.DAILY VISUAL CHECK <br /> VM.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 13 1.FLOAT MECHANISMTHAT SHUTS OFF SHEAR VALVE Q 4.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARM 0 5.TRENCH LINER iMONITORING <br /> 0 3.CONTINUOUS DISPENSER PAN SENSOR AUTO SHUT OFF FOR 0 6.NONE 469 <br /> N/A DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> M OWNER/OPERATOR SIGNATURE <br /> I certify that the mfomation provided herein is true and accurate to the beg ofmy knowledge. <br /> SI ATURE OF OWNER/ RNFOR DATE 470 <br /> '47,- 10/16/03 <br /> 1,.M'h0 OF OWNERIOPRATO160Tint) I= OF OWNER/OPERATOR 472 <br /> Amy c.Dy Agent for Owner <br /> useonly) 473 Permit Ap..d(For fo.I--dY) 475 <br />