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NIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VL PIPING. NS UCTON(ChopkadtlutaPp" UNOERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑,e.t 1�PRESSURE 112, SUCTION 3. GRAVITY 1:11. PRESSURE 132. SUCTION ❑ 3. GRAVITY CONSTRUCTIOW 9--f-SINGLE WALL ❑ 3. LINEOTRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑95, UNKNOWN MANUFACTURER ❑ 2, DOUBLE WALL ❑85. UNKNOWN ❑ 2. DOUBLE WALL ❑N. OTHER MANUFACTURER MANUFACTURER' I&1.BARE STEEL ❑ S. FRP COMPATIBLE WI 1M%METHANOL ❑ 1. BARE STEEL ❑ B. FRP COMPATIBLE WI 1M%METHANOL MATERIALS AND ❑ 2. STAINLESSSTEEL ❑ T. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTB 1195. UNKNOWN ❑ 5. PLASTIC COMPATIBLE WITH CONTENTS 11 B. FLEKIBLE(NOPE) ,❑98. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEKIBLE(MOPE) ❑99, OTHER ❑ 4. FIBERGLASS ❑ 9, CATHODIC PROTECTON ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL Val COATING. ❑95. UNKNOWN NI.PIPING LEAK DETECTION(Check W Map appM UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING v K f a w��a PRESSURIZED PIPING(Chack ep tMf apply);SINGLE WALL PIPING SINGLE ALL PIPING(Chock ed that apply): 1%(��W ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST VATH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE 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 132 MONTHLY 0.2 GPM TEST 11MONTHLY 0.2 GRH TEST 111 3.ANNUAL INTEGRITY TEST(0.1 GRH) ❑ 3. ANNUAL INTEGRITY TEST JO.1 GPM) ❑ {. DAILY VISUAL CHECK CONVENTIONAL SUCTON SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Chock all fMl apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM I TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(D.I GPM) ❑ S. TRIENNIAL INTEGRITY TEST(C 1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)+ SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) ❑ T. SELFMONITOMNG ❑ T. SELFMONITORING GRAVITY FLOW'. GRAVITY FLOW(Chock ad But appy): ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ S. DAILY VISUAL MONITORING ❑ B. BIENNIAL INTEGRITY TEST(0 1 GPM) SECONOARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Chock ad fiat appy): PRESSURIZED PIPING(ChacF all that appy): 10. COM4INM US TURBINE BUMP SENSOR W1TM AUDIBLE AND VISUAL ALARMS AND C10.CONTINUOUS TURBINE SUMP SENSOR`MTM AUDIBIF AND VISUAL ALARMS AND Irrapk am) ❑ e. AUTO PUMP SHUTOFF WHEN A LEAK OCCURS ❑ a. AUTOPUMPSHUTOFFWMENALEAKOCCURS ❑ b AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ 0, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ e NO AUTO PUMP SHUT OFF ❑ 11 AUTOMATIC LINE LEAK DETECTOR(10 GPM TEST)WITH FLOW SHUT OFF OR ❑ Tl.AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONIGRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM' ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 11 CONTINUOUS SUMP SENSOR♦AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check atl that appy) EMERGENCY GENERATORS ONLY(Chock as Mat apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ N. 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 110 GPM TESTI RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 14. ANNUAL INTEGRITY TEST(0.1 GPM) 1312. DAILY VISUAL CHECK ❑ , DAILY VISUALCHECK VIS..DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE t. a!/1N � 134, DAILYVISUALCHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS Y f�,vA ❑ S. TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑e. NONE IX OWNERIOPERATOR SIGNATURE I party tlu ah viaaa apurna 0 ew best a M knR.W,. SIG F DATE 1-3 NAMEOFOANEROPERATOR(pppB TITLE OF OWNERIOPBR•�A�T(ORW/ •},/ (i/�� PamiM1Nw b@r(w/waluw Phly) '1 Pam111 AppIwaU(FotPopluw way) Pemnl E�Ira9pn MIs(Fwroal uas way) CUPAFORM(4/99) I Formerly SWRCB Form 8