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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 �� 1 VI. PIPING CONSTRUCTION (Check all that apply) Page of_ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1. PRESSURE 2. SUCTION 3. GRAVITY 458 1. PRESSURE 2. SUCTION 3. GRAVITY 459 CONSTRUCTON F-l 1. SINGLE WALL 3. UNEDTRENCH E] 99. OTHER 460 1. SINGLE WALL 95. UNKNOWN 462 MANUFACTURER a 2. DOUBLE WALL 95. UNKNOWN 2. DOUBLE WALL E] 99. OTHER MANUFACTURER A.O. Smith J 461 MANUFACTURER 463 F] 1. BARE STEEL R 6. FRP COMPATIBLE w/10096 METHANOL 1. BARE STEEL El 6. FRP COMPATIBLE W/100% METHANOL 2. STAINLESS STEEL [:] 7. GALVANIZED STEEL 1:1 Unknown 2. STAINLESS STEEL [-] 7. GALVANIZED STEEL 3. PLASTIC COMPATIBLE W/ CONTENTS D 99. Other F1 3. PLASTIC COMPATIBLE W/ CONTENTS [:] 8. FLEXIBLE (HDPE) 99. OTHER 4. FIBERGLASS 8. FLEXIBLE (HDPE) F� 4. FIBERGLASS [j 9. CATHODIC PROTECTION E] 5. STEEL W/COATING 9. CATHODIC PROTECTION 464 [:] S. STEEL W/COATING 95. UNKNOWN 465 VII. PIPING LEAK DETECTION (Check all that apply) (A description of the monitoring program shall be submitted to the local agency.) UNDERGROUND PIPING A13UVL:bROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): F1 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT F1 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST 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. 2. MONTHLY 0.2 GPH TEST r-1 2. MONTHLY 0.2 GPH TEST 3. ANNUAL INTEGRITY TEST (0.1 GPH) F] 3. ANNUAL INTEGRITY TEST (O.1GPH) 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS (Check all that apply) 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) 7. SELF MONITORING SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW r-1 7. SELF MONITORING 9. BIENNIAL INTEGRITY TEST (0.1 GPH) GRAVITY FLOW (Check all that apply): 8. DAILY VISUAL MONITORING F1 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ALARMS AND (Check one) Q a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS F-1 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS FXJ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM F-1 b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION c. NO AUTO PUMP SHUT OFF F1 c NO AUTO PUMP SHUT OFF Rx 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT 11. AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION 12. ANNUAL INTEGRITY TEST (0.1 GPH) 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS E] 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 • F] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF " AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW F� 1 S. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) SHUT OFF OR RESTRICTION 16. ANNUAL INTEGRITY TEST (0.1 GPH) F� 16. ANNUAL INTEGRITY TEST (0.1 GPH) 17. DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT F-� 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 4. DAILY VISUAL CHECK DATE INSTALLED 468 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS E] 5. TRENCH LINER/ MONITORING 2006 Q 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR E] 6. NONE 469 DISPENSER +AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF OWN_LK/UPLKAIL)f!� ' DATE 9/27/07 4,'u NAME OF OWNER/OPRATOR(print) Daniel A Erickson Compliance Manager 4. Permit Number or local use only) Permit Approved (For local use only) ermtExpiration Date or local use only) 4"S UPCF 0 2/99 revised) 12 Formerly SWRCB Form B