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UNIFIED PROGRAM CONSOLIDATED FOR:. �� TANK: PR 8: UNDERGROUND STORAGE TANKS -TANK PAGE 2 FAC n: VI.PIPING CONSTRUCTION(o At umRpy) PW39I3 (�,k UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1.PRESSURE ❑ 2.SUCTION ❑3.GRAVITY 458 ❑ L PRESSURE11 7 ❑ 2.SUCTION ❑ 3.GRAVITY 459 tXR mL erm ❑1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 460 ❑ 1.SINGLE WALL ❑ 95.UNKNOWN 462 MANUFACTURER ❑ L ❑ 2.DOUBLEWAL95.UNKNOWN [12.DOUBLE WALL ❑ 99.OTHER ml MANUFACTURER 463 1 V ❑ 1.BARE STEEL ❑6.FRP COMPATIBLE wIopu MEiIIAMNaL El 1.BARE STEEL -16.FRP COMPATIBLE w9IW%MBTHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN [14.FIBERGLASS ❑8.FLEXIBLE(HOPE) ❑ MOTHER ❑4.FIBERGLASS ❑ e.FLEXIBLE(HDPE) ❑ 99.OTHER ❑S.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 4N ❑ S.STEEL W/COATING ❑ 9.CATHODIC PROTECTION VIL PIPING LEAK DETECTION(Chekell t 2pty)(A olaan„u"ptogaaahahx:wnotn4roe.m1 ) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING tab SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Cheek W that apply): ❑ I.ELECTRONIC LME LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WW AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH TEST ❑ 2.MONTHLY 0.2 GPH TEST ❑ J.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3.ANNUAL A'TEGAITY TEST(0.1 GPH) ❑4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Cheek all that apply) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING ❑ 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) ❑6.TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑7.SELF MONITORING ❑ GRAVITY FLOW 7.SELF MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.1)GPH GRAVITY PLOW(Cheek all that apply): [18.DAILY VISUAL MONITORING ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Cheek aB that apply): PRESSURIZED PIPING(Cheek ail Nat apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMSAND((1eeie e) ALARMSAND(CTwkaaa) ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑e. NO AUTO PUMP SHAT OFF ❑ C.NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chert au Nat apply) EMERGENCY GENERATORS ONLY(cheek athv qpy) ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF" ❑ 14.CONTINUOUS SUMP SENSOR WITHOl1T AUTO PUMP SHUT OFF" AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK VDI.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4.DAILY VISUAL CHECK DATE INSTALLED 468 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6.NONE DISPENSER+AUDIBLE AND VISUAL ALARMS 669 IX.OWNER/OPERATOR SIGNATURE I rnMy that the mfes:vi9a P:widal h by ami emeete m the hct of J Be SIGNATURE OF OWNEWOPERATOR DATE 470 NAMEOFOWNER/OPE TOR(pam) TM EOFO ER/O RATO S07I 472 Pmrttti s (Feelmal:ae9ay) 473 Perit App M(Fm l me auly) 474 Pmmt Expvevw Wu(Fa lrcaluuady) 475 UPCF(12/99 revised)