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1 06/07/2004 08:53 20946133433 FIFTH FLOOR PAGE 07 • TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 ............... YC -IFING -OXMTiEaPa of 1UNuLDROUNQLDJPIPINrj =C 1. SYSTEM 1: ABOVEGROUNDPIPINGU 2.SUCTION J.URAVETY 13 1.? El 2.SUCTION M 3.GRAVITY MANUFACTURERLSINGLEWALL [13.LINED TRENCH 0.".OTHER 459. 02 ----- 460. 11 1.SINGLE WALL 0 95.UNKNOWN 462. MANUFACTURER 95. UNKNOWN - 112.DOUBLE WALL D 9s).OTHER Akkf!STEEL El 6.M COMPATIBLE W'IDO%METHANOL1.EARE STEEL URER 463. 02.STAINLESS STEEL 117-GALVANIZED STEEL 116 1"COMPATIBLE W/100%,METHANOL E3 2 STAINLESS C] STEEL 0 7.GALVANIZED STEEL 3'PLAS-nCCOIIPATIBLE"THC.CNTENTS 11,95.UNKNOWN El 3.PLASTIC COMPATIBLE W1 CONTENTS C3 j.FLEXIBLE(HDM OIL FIBERGLASS 0 8,FLEXIBLE(BDPE) 1199.OTHER 0 4.FUIERGLASS 0 W-OTHER 05,STEELWICOATING ❑09.CATHo 0 9.CATHODIC PROTECTION OWN UNDERGROUNp PIPING 7 !" SINGLE WALL PIPING ABOVEGROUND PIPING ^� SINGLE WALL PWC PRESSURIZED PIPING(Check all that aDWY)- aG7• ❑I. ELECTRONIC PRESSURIZED PING(Chack all that apply): SHUT-OPF F0 GPH TE$7 AND SYSTEM PH TEST WITH AUTO PUMP +AUDIBLE A SYSTEM DISCONNECTION El 2. MONTHLY 03 GPH TEST +AUDIBLE AND VISUAL ALARMS. ❑2. MONTHLY O.2 GPH TE37 133- ANNUALEM�Nmn 0.1 GPH) CIS ANNUAL INTEGRITY TEST(0.1 UPHI 0 4- DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS 05' DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING CONVENTIONAL SUCTION SYSTEMS(Check all that apply) INTEGRITY TEST(0.1 OP10 [15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYMMS(NO VALVES IN BELOW GROUND PIPING): 06. TjuENNrALDrrEGiuTYTEsT(o.jGpjj) 07. SELF MONITORING SAFE SUCTION SYSTENIS(NO VALVES IN BELOW GROUND PIP,, GRAVITY FLOW 137. SELFMONfTORING G); E19- BIENNIAL INTEGRITY TEST(0.1 GPM) GRAVITY FLOW(Check a 11 that apply): L39. DAILY v7SUALMONITORrNG 09- BIENNIAL INTEGRITY TEST(al GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUSTURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. ALARMS AND(Check am) CONTINUOUS TURBINE SUMP SENSOR A1111 AUDIBLE AND VISUAL ALARMS AND(Check one) LJ I. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Ca. AUTO PUMP SHUT OFF WHEN A LEAK OCC VRS 0 D. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTFM DISCONNECTION 0 D. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 11c. NO AUTO PUMP SHur Opp DISCONNECTION 0 It. AUTOMATIC LINE LEAK DETECTOR(3-0 GPM TRIST).W111 FLOW 11c. NO AUTOPUMP SHUT OFF OFF OR RESTRICTION SHUT 0 11.AUTOMATIC LEAK DETECTOR 0 12. ANNUAL INTEGRITY TEST(0.1 GPM) 0 12 ANNUAL Mr2G RITY TEST(O.1 GPH) SUCTION/GRAVITY SYSTEM SUCTIONIGRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDIBLC AND VISUAL ALARMS 1113 CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGM'NCV GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) 014 CONTINUOUS SUMP SENSOR VEMHQYJT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS El M- 'a- CONI OUS SUMP SENSOR-WITMOI AUTO PUMP SHUT OFF 1115. AUTOMATIC LINE LEAK DETECTOR (Jo GPH TEST) NJILIM FLOW AUDIBLE AND VISUAL ALARM SHUT OFF OR RESTRICTION C)15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TFM 0 16. ANNUAL INTEGRITY TEST(0.1 OPH) ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) 13)7. DAILY VISUAL CHECK 17. DAILY VISUAL CHECK DISPENSER COMA11 E NT DATE INS we U 1. PLOAT MEC,,,,�THAT SHUTS OFF SHEAR VALVE L [14. DAILY VISUAL CMCK 40, 132. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS L35. TRENCHIL]NERMONiToRYNG [31. CONTINUOUS DISPENSER PAN SENSOR AUTO ❑ SHUT OF)z FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6. NONE Ix Ow. certify that the infom-i-provided herein -NgR/.0PERATORSIGNATU]w: 7, GNATURE OF RATOR Is Im cod Rcell"Ille to tht DeSt at my knowledge. DATE: NJ IZO I 470. 1�0ZWNER)OP 'E" (Pint): TITLE OFOWNERIOPER !Oi 0,'1 ATOR: 472 only) 73. tApproved lly( xyo$*owJ" 7. F..t Expiration Dare ftenny,=71-y)�7 UIPCF hwfw".b(1/99)-3/4 hItP:1/www.unjd*4&org Rev.02/16M