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UNIFIED PROGRAM CONSOLIDATED FO =AN RM UNDERGROUND STORAGE TANKS -TANK PAGE 2 VL PIPING C NS UCTION(Ch aM,appW UNDERGROUND PIPING bA ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE ❑ 2. SUCTION b 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 0 GMYITY CONSTRUCTION/ 9-7-SINGLE WALL ❑ 3. LINED TRENCH ❑99 OTHER ❑ 1 SINGLE WALL ❑95. UNKNOWN MAI.UFACTURER ❑ 2 DOVBLJvALL ❑95 UNKNOWN ❑ 2. DOUBLE WALL C3 99 OTHER MANUFAOTURER ' MANUFACTURER- I&1.BARE STEEL ❑ 6. FRP COMPATIBLE YVI IN%METHANOL ❑ 1 BARE STEEL ❑ 8. 5{{RQtGNPATTEfLEWn00%METMAftOD ' MATERMLS AND 2, STAINLESS STEEL T. GALVANIZED STEEL 2, STAINLESS STEEL ❑ ]:-GTLyAF9ZSO STEEL CORROSION 131113 PROTECTION ❑ 3, PLASTIC COMPATIBLE WITH CONTENTS 0 9. UNKNOVR! ❑ ]. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEKISLS(HBPE), �. • Q" OTHER , ❑ a. FIBERGLASS ❑ 8. FLEXIBLE(HDPE) 110, OTHER ❑ a. FIBERGLASS ❑ B.CATHODIC PiFOTECTION ' ❑ 5. $TE�LWI COATING ❑ 9.CATHODIC PROTECTION ❑ 5. STEEL WI COATING. 1105, UNKNOWN - 1 VIL PIPING LEAK DETECTION(Clete aMe, AW SINGLE WALL PIPING UNDERGROUND PIPING ABOVEGROUND PIPING q� PRESSURIZED PIPING(CMckap Maf apply) V ayi�.A7 PRESSURIZED PIPING(Clxk as Mafaypy) ANGLE WALL PIPIND ❑ 1 ELECTRONIC LINE LEAK DETECTOR SO GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1- ELECTRONIC UNE 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 ❑ 2 MONTHLY 0 2 GPH TEST ❑ 2 MONTHLY 0.2 GPM TEST ❑ J ANNUAL INTEGRITY TEST(0 1 GPM) ❑ S.ANNUAL INTEGRITY TEST 10.1 GPM) ❑ a. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(CheckW Met appy): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ ] SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)'. ❑ ]. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(C eak ae net appy): ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ 8. DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST 01 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check aN MM appy): PRESSURIZED PIPING(Glace an on,appy): ICneU ala) 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(c,&I one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ O AUTO PUMP DISCONNECTIONT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ O_AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c NO AUTO PUMP SHUT OFF ❑ 11 AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST R)1 GPM) ❑ 12 ANNUAL INTEGRITY TEST(0 1 GPM) SUOTIONIGRAVITY SYSTEM: SUCTIONIGRAVITY SYSTEM', ❑ 13 CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 13 CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check ap Met appy) EMERGENCY GENERATORS ONLY(Check as Mae apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND ❑ ta. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15 AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. OMLYVISUALCHECK ❑ 17. DAILY VISUAL CHECK VNL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE NK �W 13a DAILYVISUALCHEGK OATEINSTALLEO 132. CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCHUNER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SMUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑ 8. NONE R.OWNER/OPERATOR SIGNATURE I CUay 8w .a1.0 wed a eCAyfala a Ow Oast al my knaMaBpa. SIG F DATE 3 M J�LJ.�(C)(��L•�f .y M FUME OF ER ERATOR(pflpf) TT LE V1 QVINER/OPERATOR LJN Palen,NpmSar(Fw fecal v»orYy1 „•^•'•I'1 AP.4 Apprvew(Fwlaul wa wbyJ Pomnl EApnBon DaU lFwkvgl u»PIMy) 91 �00 CUPAFORM(4/99) ' ' Formerly SWRCB Forrn B