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_ D PROGRAM CONSOLIDATED A <br /> TANK <br /> UNDERGROUND STORAGE TS-TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION Checkallthat ) Page_of_ <br /> UNDERGROUND PIPING I ABOVEGROUND PIPING <br /> SYSTEM TYPE 0 1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 458 1 0 i.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 <br /> coNSTRUcncli 0 1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 0 1.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUPACTURM®2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER Western Eftr SS 461 MANUFACTURER 463 <br /> 0 1.BARE STEEL 0 6.FRP COMPATIBLE w/IWI. METHANOL 0 1.BARE STEEL ❑6.FRP COMPATIBLE W/100%-METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL I 0 Unknown 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPATIBLE W/CONTENTS - 0,99. Other 133.PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEXIBLE(HDPE) 0 99. OTHER <br /> 0 4,FIBERGLASS ®S.FLEXIBLE(HDPE) 0 4 FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 1.0 5. STEEL W/COATING 0 95.UNKNOWN 465 <br /> VM PIPING LEAK DETECTION check an thatapply)A description ofthe mondoung ppnqm shall be submitted to thelocal <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZEDPIPING(Checkall thatapply): PRESSURIZED PIPING(Chedcall that apply).. <br /> ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPHTESTt1 AUTO PUMP <br /> OFF FOR TEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> []1 MONTHLY 0.2 GPHTEST 0 z MONTHLY 0.2 a3PHTEST <br /> ❑3.ANNUAL INTEGRITY TEST(0-ICPM 0 3.ANNUAL DnTXMITY TEST(o.IGPH) <br /> 0 4, DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> 0 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING <br /> INTEGRITY TEST(0.1 CPU) ❑5.DAILY VLSUAL MONTFORING OF PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNTI)PIPING): 0 6. TRIENNIAL I TTECRITY TEST(0.1 GPH) <br /> 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPINO): <br /> GRAVITYFLOW 07. SELFMON]TORING <br /> ©9.BIENNIAL INTEGRITY TEST(0.1 GPM GRAVITY FLOW(Che*all that apply): <br /> 0 8. DAILY VISUAL MONITORING <br /> 0 9.BIENNIAL D TEGRII'Y TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PXMG SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Chack all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR Wl AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Chi one) <br /> 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> [3b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEMFAELURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> 0c. NO AUTO PUMP SHUT OFF 0c NO AUTO PUMP SHUT OFF <br /> 0 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) FLOW SHUT <br /> OFF OR RESTRICTION ®11. AUTOMATIC LEAK DETECTOR <br /> [312.ANNUAL RMGRPIY TEST(0.1 GPH) 0 12. ANNUAL INTEGRIl'Y TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 0 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 /> 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• ❑m CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF e <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> 015. <br /> AUTOMATIC LINE LEAK DETECTOR(3.0 G'H TEST)WITHOUT FLOW 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPHTEST) <br /> SHUT OFF OR RESTRICTION <br /> 0 16.ANNUAL INTEGRITY TEST(0.1 GPII) 0 16.ANNUAL INTEGRITY TEST(o.1 GM <br /> 0 17.DAILY VISUAL CHECK 0 17.DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMEATI' 0 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ©5.TRENCH LDTER/MONITORING <br /> N/A [13.CONTINUOUS DISPENSER PAN SENSOR wlTx AUTO SHUT OFF FOR 0 6.NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> M OWNEWOPERATOR SIGNATURE <br /> I cxrtify th the fiTmmation provided hereon is true and aoc rate to thebest ofmy knowledge. <br /> SIGNAWJRE OF OWNER/OPERATOR DATE 470 <br /> 10/16/03 <br /> NAME OF OWNWOPRATOR TITLE OF OWNER/OPERATOR 472 <br /> Amy C.Day Agent for O"eI <br /> Pewit Number(For localuse only) 473 Peart Approved(Fac local use only) Pemnit Expiration Date(For local Rue only) 475 <br />