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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> PIPING CONSTRUCTION check aii thx`l <br /> Eiy)UNDERGROUND PIPINNGG ABOVEGROUND PIPING Pae of <br /> SYSTEM TYPE 0 1.PRESSURE -.QJ,--SUCTION ❑3.GRAVITY 158. ❑L PRESSURE ❑2.SUCTION [13.GRAVITY 459. <br /> CONSTRUCTION/ 111.SINGLE WALL 0 3.L ED TRENCH 0 99.OTHER 460. ❑y.SINGLE WALL <br /> MANUFACTURER 0 95.UNKNOWN 462 <br /> 0 2.DOUBLE WALL 95.UNKNOWN 0 2.DOUBLE WALL 0 9%OTHER <br /> MANUFACTURER 461. MANUFACTURER <br /> 461. <br /> .BARE STEEL 0 6.PEP COMPATIBLE W/100%METHANOL 0 L BARE STEEL 0 6.FRP COMPATIBLE W1100%METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPATIBLE WITH CONTENTS 0 95.UNKNOWN 0 3.PLASTIC COMPATIBLE W/CONTENTS 0 S.FLEXIBLE(HDPE) 0 99.OTHER <br /> 0 4.FIBERGLASS 0 9.FLEXIBLE(HDPE) 0 99,OTHER 0 4.FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 164. 0 5.STEEL W/COATING 0 95.UNKNOWN <br /> 65. <br /> VIL.PIPING LEA KDETECTION.cn«k.ntn+t Aaao;rbnon6emonim' nm slWlAesubm nm to mebul ' <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466, SINGLE WALL PIPING <br /> 161. <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> -0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST MM AUTO PUMP 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> SHUT-OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION <br /> +AUDIBLE AND VISUAL ALARMS, +AUDIBLE AND VISUAL ALARMS. <br /> 0 2. MONTHLY 0.2 GPH TEST0 2. MONTHLY 0.2 GPH TEST <br /> 0 3. ANNUAL INTEGRITY TEST(0.1 GPH) i / 03. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> �/ <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING <br /> INTEGRITY TEST(0.1 GPH) [15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 116- TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW <br /> ❑7. SELF MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Chock all that apply): <br /> C19- DAILY VISUAL MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Clack all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Chock ore) ALARMS AND(Check oro) <br /> 01,AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 s. AUTO PUMP SHAT OFF WHEN A LEAK OCCURS <br /> 0 It.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION - DISCONNECTION <br /> Oc. NO AUTO PUMPSHUTOFF Oc. NO AUTO PUMPSHUTOFF <br /> ❑I1. AUTOMATIC LINE LEAK DETECTOR(3.o GPH TEST)WITH FLOW SHUT <br /> OFF OR RESTRICTION 0 11.AUTOMATIC LEAK DETECTOR <br /> ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) - 0 12.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARM$ 013. CONTINUOUS SUMP SENSOR+AUDIB LE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Cheek all that apply) <br /> 014. CONTINUOUS SUMP SENSOR WITHO AUTO PUMP SHUT OFF 0 14. CONTINUOUS SUMP SENSOR I <br /> M AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALAR <br /> 015. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW <br /> SHUTOFF OR RESTRICTION 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> 016. ANNUAL INTEGRITY TEST(0.1 GPH) 1:116. ANNUAL INTEGRITY TEST(0.1 CPN) <br /> 017. DAILY VISUAL CHECK 0 V. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAIN 469. 01. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4. DAILY VISUAL CHECK 469. <br /> DATE INSTALLED ,t 02. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [15. TRENCHILINER MONITORING <br /> `eL/J 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS 06. NONE <br /> IX.OWNER/OPERATORSICNATURE <br /> I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> ATURE F O OPERATOR DATE: <br /> 476. <br /> ° 3106 / <br /> NUIE O W(NER/OPo T (pnat ( 'ITTLy 50WNFR/OPptA�R V;1 .� �n �.e I- <br /> In. <br /> P larrtit Numberlr((Agency use only) 4]l. Permit Approved By(Agency use only) 474. Pamir Expiation Date(Ag y use oNy) 475. <br /> UPCF hwfwre-b(1/99)-3/4 http://www.unidoc&org Rev.02/16/00 <br />