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UNIFIED PROGRAM CONSOLIDATED FORM r TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 Of VI.PIPING CONSTRUCTION(Clrepk a9 thaf appy UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE F-12. SUCTION ❑ 3 GRAVITY ❑ 1 PRESSURE ❑ 2. SUCTION C33. GRAVITY CONSTRUCTION) L SINGLE WALL ❑ 3. LINED TRENCH ❑99 OTHER ❑ 1 SINGLE WALL ❑95. UNKNOWN MANUFACTURER ❑ 2 DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99.OTHER MANUFACTURER - MANUFACTURER 1.BARE STEEL ❑ 8. FRP COMPATIBLE W/100%METHANOL ❑-1. BARE STEEL 1 .06. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T.GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3 PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLE)OBLE(HDPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ B. FLEKIBLE(HOPE) 0 9.OTHER. ❑ 4FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5 STEEL W/COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING C 9. UNKNOWN VII.PIPING LEAK DETECTION(CMck an that appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check all that apply' PRESSURIZED PIPING(CAeck all that 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 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 4_ DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS'. CONVENTIONAL SUCTION SYSTEMS(Chock LI that apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST to I 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(Chack all that apply)' ❑ 9. BIENNIAL INTEGRITY TEST(01 GPM) ❑ 8 DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(0 1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING((Check a8 that apply): PRESSURIZED PIPING(Check ex that appy): 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Checkona) 10.CONTINUOUS TURBINE SUMP SENSOR`MTHAUDIBLE AND VISUAL ALARMS ANO(che<k one) ❑ a AVTOPVMPSMUTOFFWHENALEAKOCCURS ❑ a. AUTO PUMP SHUT OFF MENA LEAK OCCURS ❑ 8 AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ 8 AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ o. NO AUTO PUMP SHUT OFF ❑ d. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(30 GPM TEST)WITH FLOW SMUT OFF OR ❑ 11 AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST(O.I GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION GRAVITY SYSTEM: SUCTIOWGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 13 CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chack an that apply) EMERGENCY GENERATORS ONLY(CM k an that apply ❑ 14. CONTINUOUS SUMP SENSOR VATHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14 CONTINUOUS SUMP SENSOR WATI1OUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(30 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 18. ANNUAL INTEGRITY TEST(0.1 GRH) ❑ 17. OAILYWSVALCHECK ❑ iT. GAILY NSUAL CHECK VIII.DISPENSER CONTAINMENT OISPENSERCONTAINMENT ❑ i. FLOATMECMANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILYWSUALCHECK DATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ S. NONE DL OWNERIOPERATOR SIGNATURE I c@Mfy Nal Ne Intdmalon provided heron ie Wa and lwaawale to Na 8aM of""Mango. SIGNATURE OF CWNER/OPERATOR GATE NAME OF OWNER.'OPERATOR(poral) TIRE OF OWNERIOPERATOR Paemit NumBet(Forlocal uaa oOIy Pen I Apppvad(Forbin uaa only _ P. at EapinBon Dale(Forlpil we pNy) CUPAFORM,(4199) . • Formerly SWRCB Form B