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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VL PIPUIG CONSTRUCTION MlMck as Matappyf UNDERGROUND PIPING ABOVEGROUND PFI.G SYSTEM TYPE ❑ 1 PRESSURE ❑ 2. SUCTION 3. GRAVITY 111. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION, 1. SINGLE WALL ❑ 3. LINEDTRENCH [IN OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL ❑9S. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ 8. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE WI IDC%METHANOL MATERIALSAND ❑ 2 STAINLESS STEEL ❑ T GALVANIZED STEELCORROSION ❑ 2. STAINLESS STEEL ❑ ]. GALVANIZED STEEL PROTECTION 133 PLASTICCOMPATIBLEVATM CONTENTS 13 95, UNKNOWN 113. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE(HOPE) ❑99. OTHER a. FIBERGLASS ❑ 8. FLEXIBLE(HDPE) ❑W. OTHER Cla. FIBERGLASS 119. CATHODIC PROTECTION -AK] . STEEL W/COATING ❑ 9. CATHODIC PROTECTION ❑ S. STEEL Vp COATING ❑95. UNKNGWH NI.PIPING LEAK DETECTION(CMpk W Nq appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check aN that appy: PRESSURIZED PIPING(Check a that appy). ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUTOFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SMUT OFF FOR LEAK, LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL ALARMS ALARMS 13 2. MONTHLY 01GPM TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 3.ANNUAL INTEGRITY MST(0,1 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0,1 GPM) ❑ A. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(CIKKk aN that apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST III I GPM) ❑ 8. TRIENNIAL INTEGRITY TEST(0 1 GPM) SAFE SUCTION SYSTEMS IO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) ❑ ]. SELFMONITORING ❑ ]. SELFMONITORING GRAVITY FLOW GRAVITY FLOW(CMpk ad flratappy): 9. BIENNIAL INTEGRITY TEST 1111 GPM) ❑ a. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0 1 GPM) SECDARILY PRESSURIZED PIPING(ChaF*All that appy): SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(CMck aBMat appy): 10. CONTINUOUS TURBINE SUMP SENSOR IMTH AUDIBLE AND VISUAL ALARMS AND (CMB one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(mea arN) 13a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ e. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ C AUTO PUMP T OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ 0. ALTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SMUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)`MTM FLOW SHUT OFF OR ❑ RESTRICTION 11 gITOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST 1111 GPM) ❑ 12.ANNUAL INTEGRITY TEST to 1 GPM) SUO ON/GRAVITYSYSTEM: SUCTION/GRAVITY SYSTEM: 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(CMck as Maf apply) EMERGENCY GENERATORS ONLY(C)Wk a9 Met appy] ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 1/. CONTINUOUS SUMP SENSOR W 7`Ff0UT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)VATHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 18. ANNUAL INTEGRITY TEST to I GPM) ❑ 18.ANNUAL INTEGRITY TEST III 1 GPM) ❑ 1T. DAILYVISUALCHECR ❑ 1]. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSERCONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ A DAILYVISUALCHECK DATEINSTALLED ❑2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ S. TRENCHUNER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WTH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARM$ ❑ 8. NONE IX OWNER/OPERATOR SIGNATURE I tANy maI1M WOrmatbn pmMeee OemM is We aeM aaurate b 81a Ms1 PI my Fnpxled9e. SIGNATUREOFOWMER/OPERATOR DATE NAME OF OWNER/OPERATOR(Fdr9l TRE OF OWNER/OPERATOR Peimll Numhm(Fgbcalws acyl Pamtil ApProvaO(fwkca/vas orxyJ Parma Eapkabah DMa(For,bpa/usa wiry) - a CUPAFORM(4/99) � Formally SWRCB Form 8