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NIFI$p PROGRAM CONSOLIDATED PORN� ( I \ TANK: TAOIOZRW (� I Pit#.' PRO232029 UNDERGROUND STORAGE TANKS -TANK P 2FAC 6: FA0003767 boy VI,PRING CONSTRII(TION(Oxen nll IIxl 1pply) UNEIHI(GROIEPIPINU �Ft OIS n13OVEGNGIIND PIPING: SYSTFMTYPE ❑ I.PRESSURE 2.SVCTION ❑3.GRAVITY 0a ❑ I,PRF_SSURE ❑E.SUCTION J.GRAVITY /I! C3gIg7RDCTIUN ❑I. CLE WALL []3.LINED TRENCH ❑99.OTHER 160 ❑ I.SINGLE WALL UBLEWALL 095.IINKNGWN ❑",UNKNOWN 462 MANUFACTURER aal ❑2•DOU13LE WALL ❑99,OTRFR MANUFACTURER 4b5 ❑ L BARE STEEL ❑6.PRP COMPATIBLE w IIMHa METHANOL. [] 1.BARR STEEL M 6.FRP COMPATIBLE w lona METHAV W, ❑2,STAmLPSS STEEL ❑7.aALVANr(ED STEEL ❑1,STAINLESS STEEL ❑7.GALVANIZED STEEL ❑PLASTIC 4,FIBERGLASCOMPATIBLE W/0 A.FLi3 ❑ 95.UNKNOWN ❑PLASTIC COMPATIBLE W/CONTLMS ❑9S.UNKNOWN L�<,FIBERGLASS ❑R.FLEXRILB(HDPE.) ❑ W.O HER ❑4.FISIRRGLASS 0 S.FLRX(BLE(ROPE) ❑99.mm ❑ S.STEEL W/COAnNG ❑9.CATHODIC PROTECTION nal ❑6,STEEL WACOA'FING ❑9,CATHODIC PROTECTION 955 VII.PRONC LEAK DRTRCIIION(CIaAmIIMI (A,leerySm vTOw�nen�mlplpSpNn.mnhee�bmine9 n,rc wl,awxy.) UNDERGROUND PTPNr. PING SINGLE WALL PIPTN6 106 SINGLE ABOVEGROIOiNO PIWAX1.4PIPING PRESSURIZED PIPING(Cheek all That eppllp: PAPSSLIRI75D PIPING(CANknll th.t.pply): 467 ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.n GPH i'ESTSYJnI AUTO PUMP STRUT OFF ❑ 1.ELF.CPRONIC LINE IYAK DETECTOR.1.0 OPH TESTEY[I'RAUTO PUMP SHUT OFF PORA)L SYSTEM FAILURE.AND SYSTEM DISCONNL•(TION+AUpIBLe AND VISUAL ALARM$, FOR LEAK,SYSTEM FAILURL AND SYSTEM DISCONNP.(RION+AUDMUR AND ALARMS. VISUAL ALARMS, ❑1.MONTHLY 02 DPW TEST ❑ S.ANNUAL INTEGRITY TEST(0.1 GPM ❑2.MONTHLY 0.2 OPR TEST ❑3.ANNUAL PnwRITYTBST(0.1 OFH) ❑a,DAILY VISUAL,CHECK CONVENTIONAL.SUCTION SVSTKMS CONVENTIONAL STICTION SYSTEM..(Cb"k all 160 apply) 05.DAD,y VISUALNmn,oRMGOFPUMPMG,,;mEM+TRIENNIWL PIPING 05.DAEY V1411AI,MONTTORNC OF PLPINU AND PUMPMO SYSTEM INTEGRITY TEST(0.1 CPR)P ❑6.TRIENNIAL INiEORUTY TEST(p,I GPH) SA 7.SRIF MONITORING SUCTIONSORING (NU VALUESN BELOW CROVNDPIPING): RAPE SUCTION SYSTEMS 040 VALUES IN BELOW CROUNDMPING): GRAVITY FLOW ❑T,SELF MONITORING ❑9,BIENNIAL MTEGRrTV TEST(0.7)OPH GRAVITY PLOW(Cheek all that apply): 0 3.DAILY VISUAL MONTTORNG ❑9.BIENNIAL NTRGRmv TEST(0.1)OPIT SECONDARILY CONTAINED PI►INC SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Cbtek.n that applY)t PRRSSURILED PTPINC(Cheek 611 that apply): 10,CONTNUOUSTURRR2F.SUMP SENSOR WITH AUDIBLE AND VISUAL IO.CONTNUOUSTURBINE SUMP SENSOR M =n AUDIBLE ANO VISUAL ALARMS AND((:I.d,-x) ALARMS AND(Chink mel ❑a.AUTO P1 IMP SHUT OPP WHEN A LEAK OCCURS ❑ 6.AUTO PUMP SMUT OFP WHEN A LEAK OCCUR. ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM PAILI N,,AND SYSTEM ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ C.NO AUTO PUMP SHUT OFF ❑e, NO AID'O PUMP SHUT OFF ❑ I I.AUTOMATIC LINE LEAK DLIECTOR(3.0 GPII TEST)WITH FLOW SHUT OFF OR RESTRICTION 11.AUTOMATIC LEAK DBTPITOR ❑ ❑ 12.ANNUAL INTEGRITY TEST ID.I GPH) ❑ 12.ANNUAL MTP.ORITYTEST(OA GPH) AUCTIONKMAVITY SYSTEM SUCTION/ORAVITY RVSTRM ❑ 11.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATOR.ONLY(CMak.n PIP will EMERGENCY GENERATORS ONLY(Olen mm•N W ❑ 17.CONTINUOUS SUMP SENSOR HICLEXI AUTO PUMP SHUT OFF• ❑ 14.CONTINUOUS SUMP SENSOR Wr[jQMTT AUTO PUMP SHUT OFF• AUDIBLE AND VISUAL ALARMS AUDIDLP.AND VISUAL ALARMS ❑ 15.AUTOMATIC IJNF,LEAK DETECTOR(3.0 GPII TEST)WITH U FLAW ❑ I5.AIITOMATIC LME LBAK DETECTOR(3.0 CPR TFSTJ W FTHOUT FLOW ERUTOPFOR RESTRICTION SHUT OFPOR RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(O.1 GPH) ❑ 16,ANNUAL INTEGRITY TEST(O.I GPI( ❑ 17,DAILY VISUAL CHECK ❑ 17,DATLYVISUAL CHECK VIII.DISPENSER CONTAINMENT DISPINSERCONTAINMENT ❑ 1.nDATMECt1ANLSMTIATRtMSDFFSRFARVALVE ❑a,DAILY VISUALCHGCK DATE INSTALLED w ❑2,CONTINUOUS DISPENSER PAN SLNSOR+AUDIBLE AND VISUAL ALARMS ❑S.TRENCH LINER/MONITORING E]3.CDNTMUOUS nISPFNSER PAN SENSOR 3,VMT AUTOSITUT OFF POB ❑6.PRUNE DISPENSER+AUDIBLE AND VISUAL ALARMS '61• IN.OWNKRAIPERATOR SPGNATU I Mir,6W 11x InBTxlknpNVlhalxlNn x�m.udns.mm Ihh•n nrnry Yn„rMa,.. SIGNATURE OR ER/GPPA R BATT. /� Y !76 NAME OF OWNER/ ERATOR(oflt) TITLE OF.WNEI&PERATC)f U m 171 Pm NmbmjFwl.I..mly) 47? P,.,,m App (PwWl.v *) 474 Pwmil Oaokw.Dxe(Pm b..l u.e mlyl 475 PT0004661 EE0000817 12/31/2002 UPCF(12/99 revised)