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NIFIED PROGRAM CONSOLIDATED FORD TANK: V \/ PR ff: FAC UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(cnackau ronaPPy) Palle 3 of3 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1.PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY 458 ❑ 1.PRESSURE ❑ 2.SUCTION ❑3.GRAVITY 459 CONSTRUC110N [:11.SINGLE WALL ❑3.LINED TRENCH ❑ 99.OTHER 430 ❑ 1.SINGLE WALL ❑ 95.UNKNOWN 432 ❑2.DOUBLE WALL E195.UNKNOWN ❑2.DOUBLE WALL ❑ 99.OTHER MANUFACTURER 461 MANUFACTURER 03 ❑ 1.BARE STEEL ❑ 6.FRP COMPATIBLE w/100x,WTHMIDI. ❑ 1.BARE STEEL ❑ 6.FRP COMPATIBLE W 190X METHANOL ❑2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN ❑ PLASTICCOMPATIBLEW/CONTENTS [195.UNKNOWN [14.FIBERGLASS ❑ S.FLEXIBLE(HDPE) ❑ 99.OTHER ❑4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑99.OTHER ❑ 5.STEEL W/COATING ❑9.CATHODIC PROTECTION 434 ❑ A STEEL W/COATING ❑ 9.CATHODIC PROTECTION 43s VII.PIPING LEAK DETECTION(Chxk all that appy)(A 'emofthemmimma,mtt,rata ahaebe ebmalelm the kmt .) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 4� SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply) PRESSURIZED PIPING(Check an that apply): ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION,AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑ 2.MONTHLY 0.2 GPH TEST ❑ 2.MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4,DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) [-IS.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENMEAL PIPING ❑ 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) ❑ 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEM(NO VALUES IN BELOW GROUNDPIPING): ❑ 7.SELF MONITORING ❑ 7.SELF MONITORING GRAVITYFLOW ❑ 9.BIBNNIAI.INTEGRITY TEST(0.1)GPH GRAVITY FLOW(Check all that apply): ❑ H.DAILY VISUAL MONITORING [19.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Cheek.11 that apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Chekmc) ALARMS AND(Chault ) ❑a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ E.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM It.AUTO PUMP DISCONNECTION T OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c.NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ I L AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR ❑ 11 AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Ch kall that apply) EMERGENCY GENERATORS ONLY(C all that appy) ❑ 14.CONTINUOUS SUMP SENSOR WTIHOUT AUTO PUMP SHUT OFF• ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ SHUT OFF OR RESTRICDON SHUT OFF OR RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTALLED 468 ❑2,CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6.NONE DISPENSER+AUDIBLE AND VISUAL ALARMS 465 IX.OWNER/OPERATOR SIGNATURE I ecoiythatthe haamaemplwiBN bean k.and acetate to the bmtofmy Im twkdl, SIGNATURE OF OWNER/OPERATOR DATE 470 NAME OF OWNER/OPERATOR(print) TITLE OF OWNER/OPERATOR 0]1 4]2 Pema Nmdm(Fmloral-.9y) 473 Pmmit App Cd(FarbaaIwCcatly) 474 Permit EV"don Date(FM Imbue aly) 475 UPCF(12/99 Devised)