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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UST Tank-2 <br /> page 6 of 8 <br /> IV PIPINa.W=nDUATIn%J <br /> A.PIPING TYPE [:].ABOVEGROUND ❑1 SUCTION ❑2 PRESSURE ❑3 GRAVITY ❑!KI OTHER <br /> Check all that apply ®ii. ❑1 SUCTION ®2 PRESSURE ❑3 GRAVITY ❑99 OTHER 448 <br /> UNDERGROUND <br /> B.CONSTRUCTION [:Ij ABOVEGROUND ❑1 SINGLE WALL ❑2 DOUBLE WALL ❑3 LINED TRENCH ❑95 UNKNOWN ❑9B OTHER <br /> Check all that apply <br /> ®ii. ®1 SINGLE WALL ❑2 DOUBLE WALL ®3 LINED TRENCH ❑95 UNKNOWN ❑99 OTHER <br /> UNDERGROUND 449 <br /> C.MATERIAL AND ❑i.ABOVEGROUND ❑1 BARE STEEL ❑4 FIBERGLASS PIPE ❑8100%METHANOL COMPATIBLE WRAP ❑11 FLEXIBLE PIPING <br /> CORROSION <br /> PROTECTION ❑2 STAINLESS E]5 ALUMINUM ❑9 GALVANIZED STEEL ❑95 UNKNOWN <br /> STEEL ❑6 CONCRETE ❑40 CATHODIC PROTECTION ❑99 OTHER <br /> Check all that apply ❑3 PVC ❑7 STEEL W/COATING <br /> ®ii. ❑1 BARE STEEL ®4 FIBERGLASS PIPE ❑8100%METHANOL COMPATIBLE WRAP ❑11 FLEXIBLE PIPING <br /> UNDERGROUND ❑2 STAINLESS ❑5 ALUMINUM ❑9 GALVANIZED STEEL ❑95 UNKNOWN <br /> STEEL ❑6 CONCRETE ®10 CATHODIC PROTECTION ❑99 OTHER <br /> ❑3 PVC F-17 STEEL W/COATING 450 <br /> D.LEAK DETECTION ❑1 MECHANICAL LINE LEAK ®3 CONTINUOUS INTERSTITIAL MONITORING ®5 AUTOMATIC PUMP SHUTDOWN FOR LEAK DETECTION 8 <br /> Cheri all that apply DETECTOR SYSTEM DISCONNECTION 8 MALFUNCTION <br /> ®2 LINE TIGHTNESS TESTING ®4 ELECTRONIC LINE LEAK DETECTOR ❑990THER 450 <br /> UST TANK �I <br /> ❑1 VISUAL CHECK ®4 AUTOMATIC TANK ®7 CONTINUOUS INTERSTITIAL MONITORING ❑10 MONTHLY 1:195 UNKNOWN <br /> GAUGING(ATG) TANK <br /> TESTING <br /> CSLD set at <br /> 99% <br /> ®2 MANUAL INVENTORY ❑5 GROUNDWATER MONITORING ❑8SIR ®11 CONTINUOUS ❑99OTHER 451 <br /> RECONCILIATION ATG <br /> ❑3 VADOSE MONITORING ❑6ANNUAL TANK TESTING ❑9 WEEKLY MANUAL TANK GAUGING ❑91 NONE <br /> VI.TANK CLOSURE INFORMATION(permanent closure in place) <br /> ESTIMATED DATE LAST USED(YRMO/DAY) ESTIMATED QUANTITY OF WAS TANK FILLED WITH INERT El YES <br /> ❑ NO <br /> 452 SUBSTANCE REMAINING gal. MATERIAL? <br /> 453 454 <br /> VI.APPLICANT SIGNATURE <br /> I certify that the information provided herein is true 8 accurate to the best of my knowledge. OWNER/OPERATOR TITLE 457 DATE 458 <br /> OWNER/OPERATOR NAME(printed and signed) 456 <br /> Diane Leri Retail ESH 08113/99 <br /> Permit Approved by Permit Expiration Date <br /> 6 <br /> Formerly SWRCB Form B <br />