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Qa. oec, o-A 12,111(02- UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANKS VL PIPING CONSTRUCTION crack Al @A I P.ge�or2 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 0 1.PRESSUREUCTION0 3.GRAVITY Ise 0 1.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 CONMUCION 0 1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 40) 0 1.SINGLE WALL 0 95.UNKNOWN 46z MANIIFAMUR ffllt�DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER MANUFACTURER 161 MANUFACTURER 0 I.BARE STEEL 0 C FRP COMPATIBLE w/lwA METHANOL 0 L BARE STEEL 0 6.FRP COMPATIBLE W/I .MET Nm 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL MUnk.. 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL 0 3.PLASTIC COMPATIBLE W/CONTENTS 0 99. Other 0 3. PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEXIBLE(HDPE) 0 99. OTHER 0 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) 04. FIBERGLASS 0 9.CATHODIC PROTECTION 0 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING 0 95.UNKNOWN 469 VII.PIPING LEAK DETECTION Check Al mat Adaai t,nofine mvniton Anal be mpbmmcd to then, UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING abb SINGLE WALL PIPING 467 PRESSURIZED PIPING(Clack an Out apply): PRESSURIZED PIPING(Check At that apply): 0 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST Wali AUTO PUMP OFF FOR L EAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. 0 2.MONTHLY 0.2 GPH TEST 02. MONTHLY 0.2 GPH TEST [13.ANNUAL INTEGRITY TEST(0.IGPH) 0 3.ANNUAL INTEGRITY TEST(0.1 GPH) 04. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check At mat apply) 0 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELF MONITORING 0 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check AI thn apply): 0 8. DAILY VISUAL MONITORING 0 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(cheAt an thin apply): PRESSURIZED PIPING(ch« AI that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check one) ALARMS AND(Q am) 0. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a 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 On. NO AUTO PUMP SHUT OFF On NO AUTO PUMP SHUT OFF 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 0 11 AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION 0 12. ANNUAL INTEGRITY TEST(0.1 GPI) [112. ANNUAL INTEGRITY TEST(0.1 GPH) SSdUCTY ION/GRAVITY SYSTEM SUCTION/GRAVHSYSTEM QPU. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all mat apply) EMERGENCY GENERATORS ONLY(Chcd AI tM1m apply) 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF e 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) 0 16.ANNUAL INTEGRITY TEST(0.1 GPI) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) 0 17. DAILY VISUAL CHECK 0 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 0 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 94.DAILY VISUAL CHECK DATE INSTALLED 468 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 5.TRENCH LINER/MONITORING U(\'c'4\Qlk/<\ 0 3.CONTINUOUS DISPENSER PAN SENSOR WIT AUTO SHUT OFF FOR 0 6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE 1 wa*thA On iaronnelion navkh tl hetero u Ups aM accume m me bat or my knowledge. SIGNAP"OtWOPERAT DATE 479 l('Zb aZ NAM FOWNER/OP TOR(print) 471 TITLE OF OWNER(OPERATOR 472 o NA D2P 1 1G8E Pmnit Namber(Fm local use only) 473 Permit AWOVr (Forlmalusaonly) 474 Parmit Eapimtlan Dain(Pur local use only) 479 UPCF(12/99 revised) 12 Formerly SWRCB Form B