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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VL PIPING CONSTRUCTION(Cheek 0 MatappW UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE ❑ 2. SUCTION GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 0. GRAVITY CONSTRUCTION/ W.- SINGLE ALl 1 ❑ 3. LINED TRENCH 1199 OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER ❑ 2 DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER 1 BARE STEEL ❑ 6. FRP COMPATIBLE Wl 100%METHANOL ❑ 1. BARE STEEL ❑ 0. FRP COMPATIBLE W/100%METHANOL MATERIALSAND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVAyVEDSTEEL CORROSION FFF�� PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ ]. RUSTIC COMPATIBLE NTH CONTENTS y"LA(IQ4tHDPE) �q�9,OTMEfl ❑ 4. FIBERGLASS ❑ S. FLEXIBLE(HDPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTESVOA,• r 19t, ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION I 10 11. STEEL W/COATING ❑95. UNKNOWN VII.PIPING LEAK DETECTION(CMck Y MN appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(CMFk a9 Mat apply): PRESSURIZED PIPING(CMck ad Mal apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH 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 ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2. MONTHLY 02 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GRH) ❑ ]. ANNUAL INTEGRITY TEST(0.1 GPX) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Clreck0 Nat appy): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST to.1 GPM) ❑ R. TRIENNIAL INTEGRITY TEST(0.11 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS INO VALVES IN BELOW GROUND PIPING)', ❑ 7. SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOW'. GRAVITY FLOW(CMCk a9 that apply): ❑ 9. BIENNIAL INTEGRITY TEST to 1 GPM) ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0 1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(CMck aN that appy): PRESSURIZED PIPING(C)Ieck ad that appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (O, c OM) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Neck me) ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SMUT OFF MEN A LEAK OCCURS ❑ e AUTO PUMP SMUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ p. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DIS ❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)NTH FLOW SHUT OFF OR RESTRICTION ❑ 11, AUTOMATIC LEAK DETECTOR ❑ 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 ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(CM rk aR that appy) EMERGENCY GENERATORS ONLY(Crack Ad Mat appM ❑ 14. CONTINUOUS SUMP SENSOR WTHOUT AUTO PUMP SHUT OFF-AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15.AUTOMATIC UNE LEAK DETECTOR(3.0 GPX TEST)WITHOUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 19.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 1R. ANNUAL INTEGRITY TEST(01 GPM) ❑ 17. DAILYVISUALCHECK ❑ 17. DAILY VISUAL CHECK VOL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. WILYVISUALCHECK DATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR u AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ R. NONE 1);.OWNER/OPERATOR SIGNATURE I aaH9k Nal Ma INmnelim prMa d Myth la We aM a4VnM W pia pat at My kt aa,d9a SIGNATURE OF OWMERK)PERATOR BITE NAME OF OWNERIOPERATOR IprMO TITLE OF OWNEROPERATOR Pamir Namper(For loch uaa oMy) Permit App.W(Fmkral ma oMy) pa mad Engn4orI DM(Forkaal uaa aNy) CUPAFORM(4/99) J �^ Formerly SWRCB Form B