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*41T'NIFIED PROGRAM CONSOLIDATED FO M TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(CM "IllatappW UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER ❑ 2 DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL [IN. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ B. FRP COMPATIBLE WI 100%METHANOL ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE WI 100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ Z GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 1195 UNKNOWN 113. PLASTIC COMPATIBLE WITH CONTENTS 11a. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE(HDPE) ❑90. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5 STEELWICOATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEELWICCATINO ❑95. UNKNOWN VII.PIPING LEAK DETECTION(CMG ap Mabppy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chad ak Mat appy): PRESSURIZED PIPING(Check.0 Mat apptA ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL ALARMS ALARMS ONTHL ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2.AN MONTHLY LY OZ GPM ITY TESEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ ]. ANNUAL INTEGRITY TEST I0.1 GPM) ❑ 4. GAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(CMck ap Mat apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM r TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST III I GPM) ❑ e. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)'. ❑ T. SELFMONITORING ❑ T. SELFMONITORING GRAVITY FLOW GRAVITY FLOW(CM k a9 tMf appy): ❑ 9. BIENNIAL INTEGRITY TEST 10.1 GPM) ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0 1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all MM apply): PRESSURIZED PIPING(CMck ak Mal appy): 10 CONTINUOUS TURBINE SUMP SENSOR WITHAUDIBLE AND VISUAL ALARMS AND (Check aha) %CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Ned Ona) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ E AUTO SHUTOFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION TION ❑ b_ AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION DIS ❑ I.NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(i9 GPM TESTI WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RES(RICTION ❑ 12. ANNUAL INTEGRITY TEST IO.I GPM) ❑ 12. ANNUAL INTEGRITY TEST 10.1 GPM) SUCTIONK RAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR a AUDIBLE AND VISUALAIARMS EMERGENCY GENERATORS ONLY(Chant M Ihal apply) EMERGENCY GENERATORS ONLY(CMck as tAat appy) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL LA VISUALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(10 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ IL DAILYVISUALCHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. OAILYVISUALCMECK DATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER I MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUOIBLE AND VISUAL ALARMS ❑e. NONE 11(.OWNERIOPERATOR SIGNATURE I e.l9y MMMe inl ab,el pmkiBaE herein Is Wa aM a raM M"beg a!myk gripe. SIGNATUREOFOWNERIOPERATOR DATE NAME OF OWNERIOPERATOR f nno TITLE OF OWNEMPERATOR Permit Number(For tical us A*) Panni)Appmaep IF&local uaa wdy) PamM EapkaOpn Dm(Fa bcL uta aVyl CUPAFORM(4199) Formerly SVVRCR Form 8