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UNIFTED PROGRAM CONSOLIDATED FORM - TANKS UNDERGRAD STORAGE TANKS - TANK PAGE 2 VI.PIPING CUNSTRUCI'LON chalk ail unx PI Pa e 3 of 3 UNDERGROUND PIPING ABOVEOROUND PIPING SYSTEM TYPE 0 1.PRASSIIRE ®2.SUCTION 0 3,GRAVITY 450. 0 1.PRESSURE 0 2.SUCTION CONSTRUCTION/ ❑3.GRAVITY 459. MANUFACTURER 0]'SINOLe WAIL ❑3.LINEA TRENCH 0 99.OTHER 40 0 1.SINGLE WALL ❑95.UNKNOWN 462. 0 2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WAIL ❑99.OTHER MANUFACTURER 461. MANUFACTURER FLETCHER COATING 463. ®1.BARB STEEL ❑6.PAP COMPATIBLE W/IOOX METHANOL ®t.HARE STEHL 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 6.FRP COMPATIBLE W/IDO•A METHANOL ❑2,STAINLESS STEEL ❑7.GALVANIZED STHEl. 113 PLASTIC COMPATIBLE WITH CONTENTS 0 95.UNKNOWN ❑3.PLASTIC COMPATIBLE W/CONTENTS 0 S.FLEXIBLE(HOPE) 0 99,OTHER 0 4.FIBERGLASS 0 8.FLEXIBLE(HOPE) 0 99.OTHER ❑4.FIBERGLASS 0 9,CATHODIC PROTECTION 0 S.STEEL W/COATING 0 9.CATHODIC PROTECTION 464, ❑S.STEEL W/COATING 1195 UNKNOWN 465. Yu. UNDERGROUNDIEPPWGE ION(Check 4II t1Yl: Adyedpaaa or the monk - re ,e4 rIs wb.attw to VEO OUNDPPINO l.a I SINGLE WALL PIPING 465. SINGLE WALL PIPING 467. PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 131 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESL WITH AUTO PUMP 0I ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST KrITTi AUTO PUMP SHUT-OFF FOR LEAK,SYSTEM F AILURA AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. [12. MONTHLY 0.2 GPH TEST [32- MONTHLY 0.2 GPH TEST 03. ANNUAL INTEGRITY TEST(0.1 GPH) 0 3. ANNUAL INTEGRITY TEST(III GPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Clmck all that apply) 0 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 VALVES INBELOW GROUND PIPING): C36. TRIENNIALINTBGRITY TEST(0.1 GPH) 07. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELF MONITORING C39. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): [18. DAILY VISUAL MONITORING 139. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check a0 that apply): PRESSURIZED PIPING(Check a0 that apply): 10. CONTINUOUS TURBINE SUMP SENSOR I!"11T{ AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR 3Y1Tfi AUDIBLE AND VISUAL ALARMS AND(Check one) ALARMS AND(Cheek ow) 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [J. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b.AUTO PUMP SHUT OFF FOR LEAKS SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Dc. NO AUTO PUMP SHUTOFF Dc. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)W ITI4 FLOW SHUT OFF OR RESTRICTION ❑11. AUTOMATIC LEAK DETECTOR ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 0 13, CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 015. AUTOMATIC LINE LEAK DETECTOR (3.0 OPH TEST) WIT FLOW SHUT OFF OR RESTRICTION 0 15, AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) 0 16. ANNUAL INTEGRITY TEST(0.1 GPH) 0 16, ANNUAL INTEGRITY TEST(0,1 GPH) 017. DAILY VISUAL CHECK 0 17. DAILY VISUAL CHECK VDL DISrENSM CONTAINMENT.-- DISPENSER CONTAINMENT 46b, DI. FLOAT MECHANISM THAT SHUTS OFF STIEAR VALVE 04. DAILYVISUALCHECK 469. DATE INSTALLED [12, CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 5. TRENCHR.INER MONITORING [33. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR N/ADISPENSER+AUDIBLE AND VISUAL ALARMS ®6. NONE DL OWNER/OPERATOR SIONATU,[iE- I certify that the information provided herein is true and accurate to the best ofmy knowledge. SIONATUMqF OWNER/OPERATO DATE: 470. !2 NAME OP OWNER/OPERATOR t); A.WDRIEW TAYLOR TITLE OF OWNER/ PERA O IRONMENTAL MANAGER 4n' Pamdl Nenikr(ABeeey ma^Wy) 471 Permit Approved By(Agency ase only) 474. Permit ENtfiauon Dale(Agency use only) 475, RECEIVED FEB-11-04 15:09 FROM-9168581011 TO-KLEEMAN ROEBBELEN PAGE 18