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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Chia no Met apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE ❑ 2. SUCTION �. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 0. GRAVITY CONSTRUCTION/ ❑ 1. SINGLE WALL ❑ 0. LINEDTRENCH ❑99. OTHER ❑ 1. SINGLE WALL 1195, UNKNONM MANUFACTURER ❑ 2 DOUBLEWALL ❑95. UNKNONrtd ❑ 2 DOUBLEWALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ e. FRP COMPATIBLE W/I00%METHANOL ❑ 1. BARE STEEL ❑ e. FRP COMPATIBLE W/10%METHANOL MATERIALSANO ❑ 3. STAINLESS STEEL ❑ T.GALVANREDSTEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION •FyT/ PROTECTION ❑ B. PIASTICCOMPATIBLEWTHCONTENTS yy95. UNKNOWN ❑ ]. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8 FLEXIBLE(NOPE) El 99, OTHER ❑ 4. FIBERGLASS ❑ B. FLEKIBLE(MOPE) '❑99. OTHER ❑ 4. FIBERGLASS ❑ B. CATHODIC PROTECTION ❑ 5. STEELW/CDATING ❑ 9.CATHODIC PROTECTION 10 5. STEELW/CDATING ❑95. UNKNOWN WI.PIPING LEAK DETECTION(Class a/fealapp4l UNDERGROUND PIPING ABOVEGROUNO PIPING SINGLE WALL PIPING SINGLE WAIL PIPING PRESSURIZED PIPING(Chock as M t appy): PRESSURIZED PIPING(Cock of Mat apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 0.0 GPM TEST NTH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 8.0 GPM TEST NTH 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 112. MONTHLY 0.2 GPM TEST ❑ 3. MONTHLY GPH TEST 11S ANNUAL INTEGRITY TEST(0.1 GPM) ❑ dANNWLINTEGRITY TEST(0.1 GPM) ❑ 4, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Chocka far appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ 8. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING). ❑ T. SELFMONITORING ❑ T. SELFMONITORING GRAVITY FLOW GRAVITY FLOW(Cock aM fat appy) 9. BIENNIAL INTEGRITY TEST(0 1 GPH) ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0 1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(ChNk aft fabpply): PRESSURIZED PIPING(Chock 80 that apply)' 10. CONTINUOUS TURBINE SUMP SENSOR NTH AUDIBLE AND VISUAL ALARMS AND (Check Pro) 10.CONTINUOUS TURBINE SUMP SENSOR NTH AUDIBLE AND VISUAL ALARMS AND(C11eO oro) ❑ a AUTO PUMP SHUT OFFWNEN A LEAK OCCURS ❑ a. AUTOPUMPSHUTOFFNMENALEAKOCCURS ❑ B AUTO PUMP T Off FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ 0. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ C. NOAUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(0.0 GPM TEST)NTH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST to 1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0 1 GPM) SUCTIOWGRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: ❑ 15. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 10. CONTINUOUS SUMP SENSOR r AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Cock as that appy) EMERGENCY GENERATORS ONLY(Cock as that apply) ❑ 14 CONTINUOUS SUMP SENSOR WTHOUT AUTO PUMP SHUT OFF-AUDIBLE AND 1314 CONTINUOUS SUMP SENSOR WTHOUT AUTO PUMP SHUT OFF-AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)W THOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(70 GPM TEST) RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST to 1 GPM) ❑ 1e. ANNUAL INTEGRITY TEST to 1 GPM) ❑ 17. DAILYVISUALCHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2, CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER/MONITORING ❑ 8 CONTINUOUS DISPENSER PAN SENSOR NTH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑a. NONE 11 OWNER/OPERATOR SIGNATURE I"rely Mat the Nlo)maaon PNVHaO IIaNin is Mat sa acsutaM W 9r Oaal of my[novAao'9a. SIGNATURE OF O'hMERIOPt:.,ON DATE NAME OF CANER/OPERATOR flan" TITLE OF OMIEP/OPERATOR Prmil NM (Forbcaluaa wMl PannA APPw (Fork l Me oNH Penh Expitalgn DaM(FPrhKL uae oNy) CUPAFORM(4199) Formery SWRCB Form B