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UNIFIED PROGRAM CONSOLIDATED FORM � <br /> TANKS <br /> UST Tank-2 <br /> Page 8 a 8 <br /> A.PIPING TYPE ❑L ABOVEGROUND ❑1 SUCTION ❑2 PRESSURE <br /> ❑3 GRAVITY ❑99 OTHER <br /> Check all that apply ®ii. ❑1 SUCTION ❑2 PRESSURE <br /> ®3 GRAVITY ❑99 OTHER 448 <br /> UNDERGROUND <br /> B.CONSTRUCTION ❑i ABOVEGROUND ❑1 SINGLE WALL ❑2 DOUBLE WALL ❑3 LINED TRENCH <br /> ❑95 UNKNOWN ❑99 OTHER <br /> Check all that apply ❑ii. ❑1 SINGLE WALL ❑2 DOUBLE WALL <br /> ❑3 LINED TRENCH ❑95 UNKNOWN ❑990THER <br /> UNDERGROUND <br /> 449 <br /> C.MATERIAL AND ❑I.ABOVEGROUND ❑1 BARE STEEL ❑4 FIBERGLASS PIPE <br /> CORROSION ❑8 700%METHANOL COMPATIBLE WRAP ❑11 FLEXIBLE PIPING <br /> PROTECTION ❑2 STAINLESS ❑5 ALUMINUM ❑9 GALVANIZED STEEL ❑95 UNKNOWN <br /> STEEL ❑6 CONCRETE ❑10 CATHODIC PROTECTION ❑99 OTHER <br /> Check all that apply ❑3 PVC ❑7 STEEL W/COATING <br /> ❑N. ❑1 BARE STEEL ❑4 FIBERGLASS PIPE ❑8 100%METHANOL COMPATIBLE WRAP ❑11 FLEXIBLE PIPING <br /> UNDERGROUND ❑2 STAINLESS ❑5ALUMINUM ❑9 GALVANIZED STEEL <br /> ❑95 UNKNOWN <br /> STEEL ❑6 CONCRETE ❑10 CATHODIC PROTECTION ❑99 OTHER <br /> ❑3 PVC ❑7 STEEL W/COATING 450 <br /> D.LEAK DETECTION ❑1 MECHANICAL LINE LEAK DETECTOR ❑3 CONTINUOUS INTERSTITIAL <br /> ❑5 AUTOMATIC PUMP SHUTDOWN FOR LEAK DETECTION 8 <br /> Check all that apply MONITORING SYSTEM DISCONNECTION 8 MALFUNCTION <br /> ❑2 LINE TIGHTNESS TESTING ❑99 OTHER 450 <br /> ❑4 ELECTRONIC LINE LEAK DETECTOR <br /> UST TANK �I <br /> ❑1 VISUAL CHECK ❑4 AUTOMATIC TANK ®7 CONTINUOUS INTERSTITIAL MONITORING ❑10 MONTHLY 095 UNKNOWN <br /> GAUGING(ATG) TANK <br /> TESTING <br /> CSLD set at <br /> 99% <br /> 02 MANUAL INVENTORY ❑5 GROUNDWATER MONITORING ❑8 SIR ❑11 CONTINUOUS ❑990THER 451 <br /> RECONCILIATION ATG <br /> ❑3VADOSE MONITORING ❑6 ANNUAL TANK TESTING ❑9 WEEKLY MANUAL TANK GAUGING El 91 NONE <br /> VI.TANK CLOSURE INFORMATION(permanent closure in place) <br /> ESTIMATED DATE LAST USED(YR411OIDAY) ESTIMATED QUANTITY OF WAS TANK FILLED WITH INERT ❑ YES ❑ NO <br /> 452 SUBSTANCE REMAINING gal. MATERIAL? <br /> 453 454 <br /> V1.APPLICANT SIGNATURE <br /> I certify that the information provided herein is mis 8 accurate to the best of my knowledge_ OWNER/OPERATOR TITLE 457 DATE 458 <br /> OWNER/OPERATOR NAME(printed and signed) 456 <br /> D.R. Leri Retail ESH 8/13/99 <br /> Permit Approved by Perk Expiration Date <br /> 8 <br /> Formerly SWRCS Form B <br /> \� \.{ <br />