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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION (CheckeUMal appl)q _ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1. PRESSURE 2. SUCTION ❑ 3 GRAVITY ❑ 1. PRESSURE I . SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ 1. SINGLE WALL 3. LINED TRENCH ❑ 99 OTHER ❑ 1. SINGLE WALL _j MANUFACTURER y❑ W ❑ 2. DOUBLE WALL �I 95. UNKNOWN UNKNOWN ❑ 2. DOUBLE WALL MANUFACTURER 9. OTHER MANUFACTURER ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE W/ 100% METHANOL ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE Wt 100% METHANOL MATERIACORROSION AND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL k� ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS S. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTE S ❑ 8. FLEXIBLE (HDPE) ❑ 99. OTHER 4. FIBERGLASS ❑ 8. FLEXIBLE (HDPE) 1:199, OTHER. ❑ 4. FIBERGLASS ❑ 5. STEEL WI COATING ❑ 9. CATHODIC PROTECTION CATHODIC PROTECTION ❑ 5. STEEL W/ COATING 95. UNKNOWN - VII. PIPING LEAK DETECTION (Check al that eppty} UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING PRESSURIZED PIPING (Cneck all that apply): SINGLE WALL PIPING PRE RIZED PIPING (Chan that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION - AUDIBLE AND VISUAL ECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT F FOR LEAK, SY TEM FAILURE, AND SYSTEM DISCONNECTION . AUOIBIE AND VISUAL ALARMS ❑ 2. MONTHLY 0.2 GPM TEST RMS ❑ 2. MON LY 0 2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0 1 GPM) ❑ 3. ANNUAL TEGRITY TEST (0.1 GPM) ❑ 4. DAILY VISU CHECK CONVENTIONAL SUCTION SYSTEMS. CONVENTIONAL SUCTI N SYSTEMS (Check all that apply): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM • TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MO TORING OF PIPING AND PUMPING SYSTEM TEST (0 1 GPH) ❑ 8 TRIENNIAL INTEGRI TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING SAFE SUCTION SYSTEMS (NOV VES IN BELOW GROUND PIPIN ❑ 7. SELF MONITORING GRAVITY FLOW El 9. BIENNIAL INTEGRITY TEST (0 1 GPH) GRAVITY FLOW (Check all that apply): ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONOARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply) SECONOA YC TAINED PIPING PRESSURIZED PIPING (Check all that apply): 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Cneck one) ❑ a AUTO PUMP SHUT 10. CONTINUOUS TURBINE SUMP SENSOR WMT UOIBLE AND VISUAL ALARMS AND (check one) OFF WHEN A LEAK OCCURS ❑ b AUTO PUMP SMUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM ❑ a. AUTO PUMP SHUT OFF WHEN A L KOC URS DISCONNECTION 11b AUTO PUMP SHUT OFF FOR LEA S, SYSTE AILURE AND SYSTEM DISCONNECTION ❑ C. NO AUTO PUMP SHUT OFF ❑ C. NO AUTO PUMP SHUT OFF ❑ 11 AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) WITH FLOW SHUT OFF OR ❑ 11 AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12 ANNUAL INTEGRITY TEST (C 1 GPH) ❑ 12. ANNUAL INTEGRITY TEST (0. GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: 13 CONTINUOUS SUMP SENSOR • AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SE SOR • AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR EM GENCY GENERATORS ONLY (Check all that ly) WITHOUT AUTO PUMP SHUT OFF. AUDIBLE AND VISUAL ALARMS ❑ 14. CONTINUOUS SUM SENSOR WITHOUT AUTO PUMP SHUT OFF . AUO LE AND VISUAL ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) RESTRICTION ❑ 18. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 18. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VHL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER /MONITORING ❑ 3 CONTINUOUS DISPENSER PAN SENSOR VATH AUTO SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ❑ 6. NONE IX. OWNERIOPERATOR SIGNATURE I carbty that the infonmauon provided herein is We and accurate to the best of my knowledge. SIGNATURE OF OWNERIOPERATOR DATE W )a NAME OF G, W`IER)OPERATOR (pifnIT TITLE OF O ERrOPERATOR W L Z CA S 'T-4i-V7T) Permd Number (Forlccal use onW Permit Approved (Forlocal use only) Permit P. i_'r n.'. 'c ' r....r,,.. CUPAFORM (4/99) Formerly SWRCB Form B