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UNIFIED PROGRAM CONSOLIDATED FORM �1�Q5t7W TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check an that appy) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE ❑ 2. SUCTION 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTIOW 1 SINGLE WALL ❑ 3. LINEDTRENCH 1199 OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MAN,4FACTURER MANUFACTURER 1.BARE STEEL ❑ B. FRP COMPATIBLE WI IW%METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE WI 100%METHANOL MATERIALS AND ❑ 2 STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE NTH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE HATH CONTENTS ❑ B. FLEXIBLE(HDPE) Be❑ . OTHER ❑ 4. FIBERGLASS ❑ B. FLEXIBLE(HDPE) ❑N. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEELWICOATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑95. UNKNOWN VII.PIPING LEAK DETECTION(Check aN Mat appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALLPIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check ak that appW: PRESSURIZED PIPING(Check ak Tat apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH 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 GPH TEST 13 2. MONTHLY0.2GPHTEST El 3, ANNUAL INTEGRITY TEST(0.1 GPH) 11J. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that applyp ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST I GPH) ❑ S. TRIENNIAL INTEGRITY TEST(0 1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW(Checkoll that apply): ❑ 9, BIENNIAL INTEGRITY TEST(0.1 GPH) ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0 1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that appy): PRESSURIZED PIPING(Check aN that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check chat ❑ a. AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ b AUTO PUMP DISCONNECTION 11 OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ b_ AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11 AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11, gUTOMl1TIC LEAN DETECTOR ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12. ANNUAL INTEGRITY TEST(01 GPH) SUCTIOWGRAVITY SYSTEM. SUCTIONIGRAVITY SYSTEM. ❑ 13. CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all Mat appy) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF a AUDIBLE AND ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUALAIARM$ ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR 13.0 GPH TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION ❑ 10. ANNUAL INTEGRITY TEST(0 1 GPH) ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VRL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR a AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCHUNER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUTOFF FOR DISPENSER a AUDIBLE AND VISUAL ALARMS ❑ 6. NONE IX OWNER/OPERATOR SIGNATURE I rend,Net Na infohnauon Pmaidad herein is true and accurate 0 Me best of my knoore 1p SIGNATURE OF OWNERIOPERATOR GATE NAME OF OWNER/OPERATOR(pdnU TITLE OF OVMERIOPERATOR Permit Number(For local we only) Permit ApPmved(Far local we only) Permit Expiration Date(For local use only) CUPAFORM(4/99) Formerly SWRCB Form 8