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UNIFIED PROGRAM CONSOLIDATED FORM 1poll 1�- 4 t TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VL PIPING CONSTRUCTION aq mat ) p Z UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [(I.PRESSURE 117 SUCTION ❑3.GRAVITY 4M 0 I.PRESSURE ❑2. SUCTION ❑3.GRAVITY 45s CONS1R6C1K9y1 ❑I.SINGLE WALL ❑3.UNEDTRENCH ❑99.OTHER 460 ❑1.SINGLE WALL ❑95.UNKNOWN 462 MANUFACIUIER R1 2.DOUBLE WALL D 95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461 MANUFACTURER_ 469 0 BARE STEEL 06.FRPCOMPATIBLE aa/I9 M6lMANOL 0 BARE STEEL ❑6.FRP COMPATIBLE W/lomr.MITFIANOL ❑.yy 2.STAIN]FSS STEEL 117.GALVANIZED STEEL ❑Unkmwe ❑2. STAINLESS STEEL ❑7,GALVANIZED STEEL 193_PLASTIC COMPATIBLE W/CONTENTS ❑99. Odwe 133. PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPE) ❑99. OTHER ❑4.FIBERGLASS F]S.FLEXIBLE(HDPE) ❑4. FIBERGLASS ❑9 CATHODIC PROTECTION ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 41M ❑5. STEEL W/COATING ❑95.UNKNOWN 465 VIL PIPING LEAK DETECnON(c6 aanmu )(Ae cn otm.ausni al,.y 1,esubm;,,�.lia b,.y ,) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING aab SINGLE WALL PIPING 467 PRESSURIZED PIPING(Clad A aNc appy) PRESSURIZED PIPING(Clock d my appy) EX 1.ELECTRONIC UNE LEAK DETECTOR 3.0 GFH TEST WITH AUTO PUMP SHUT ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. N 2.MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST ®3.ANNUAL INTEGRITY TEST 10 IGPH) ❑3.ANNUAL INTEGRITY TEST(0.IGPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chat as ma appy) El 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) 05. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6.TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑Z SELF MONITORING ❑9.BIENNIAL INTEGRITY TEST 10.1 GPH) GRAVITY FLOW(Click aO ma appy): O6. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIING PRESSURIZED PIPING(Click a0 mac apply). PRESSURIZED PIPING(Ckack a mas appy} 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSORS AUDIBLE AND VISUAL yy AALyLARMS AND(Cc ok oee) ALARMS AND(Cheek ) )fa. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 19 It. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Oc, NO AUTO PUMP SHUT OFF [3c NO AUTO PUMP SHUT OFF [XIl. AUTOMATICUNE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT ,FF OR RESTRICTION ❑11. AUTOMATIC LEAK DETECTOR ❑12. ANNUAL INTEGRITY TEST(O.l GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCITONIGRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS E3 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(clackap mal appy) EMERGENCY GENERATORS ONLY(Cheek ae mu appy) 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION 15. AUTOMATIC LINE LEAK DETECTOR(3 0 GPH TEST) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0.1 GPM) ❑17. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VIIL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATEINSTALLED 464 02.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER f MONITORING 2001 TI$3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 6,NONE 4w DISPENSER+AUDIBLE AND VISUAL ALARMS ITL OWNERIOPERATOR SIGNATURE imuy d mrr�m mehm oTAr kwwkaye OFO E OR DATE am WN R. (pnpt) 1 471 TITLE OFOWNER145PERATOR 4n EY LEE PROJECT MANArRR Pemn Num6c(For krw"'eery) m a it App�(For low use eery) 474 Pamm Fspaaao„Date(I'm use only) 471