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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 W.PIPING CONSTRUCTION(OMIYYIMrappw UNDERGROUND PIPING ABOVEGROUND PIPING SYSEM TYPE ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTIOW ❑ 1. SINGLE WALL a 3. UAW TRENCH ❑W. OTHER ❑ 1. SINGLE WALL ❑SS UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL Xmw UNKNOWN ❑ 2. DOUBLEVMLL ❑9B.OTHER MANUFACTURER MANUFACTURER 1.BARE STEEL ❑S FRP COMPATIBLE W 10(M METHANOL ❑ 1. BARE STEEL ❑ 5. FRP COMPATIBLE W 100%METHANOL MATERIALS AND ❑ 2 STAINLESS STEEL ❑ i.GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ LA 3. PSTICCOMPATIBLEVATH1CONTENTS ❑95. UNKNOYM ❑ 3. PLASTICCOMPATIBLEW13EX TMCONTENTS B. FLIBLEMOPE) 11 W. OTHER ❑ a. FIBERGLASS 119. FLEXIBLE(HOPE) ❑99. OTHER 11a. FIBERGLASS ❑ 9.CATH O=PROTECT)N ❑ 5. STEEL W COATING ❑ 9.MTMODIC PROTECTION ❑ 5. STEEL W COATING ❑95. UNKNOWN VK.PIPING LEAK DETECTION(CM aF apply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(CM 0NMl aPPW. PRESSURIZED PIPING(CMM aFnw appy): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WTH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK OETECTOR 3.0 GPH TEST W TH AUTO PUMP SHUT OFF FOR LEAK LEAK.SYSTEM FAILURE.AND SYSTEM DISCONNECTION♦AUDIBLE ANO VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE ANO VISUAL ALARMS ALARMS TEST ES ❑ 2 MONTHLY 0.2 GPM TEST 13 2. MONTHLY GPM El 3. ANNUAL INTEGRITY TEST(0.1 GPM) 11 3 ANNUAL INTEGRITY GRITY TTEST(0.1 GPMI ❑ A. WILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTFJAS lGNck sI Ma appy): ❑ S. MILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ S. MILYMI LMONITOMI OFPIMN ANOPUMRN SYSTEM TEST(0.1 GPH) ❑ 6. TRIENNIAL INTEGRITY TEST(01 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROIMO PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ '. SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(LING aI Mal apply): ❑ 9. MENNIALINTEGRITYTEST(DIGPH0 ❑ S. DAKYVISUALMONTORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING rL k NIM"WW PRESSURIZED PIPING(O 0PINI apgM: la CDMTNUOl.S TURBINE SUMP SENSOR vATiAUDIBLE AND VISUAL ALARMS AND 10 CONTINUOUS TURBINE SUMP SENSOR WTH AUDIBLE AND VISUAL ALARMS AND(dNG ons) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ 0. AUTO WARP SHUT OFF F00.LEAKS,SYSTF2I FAILURE AND SYSTEM DISCONNECTION 130. 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 UNE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ f 1. AUTOMATIC LEAK DETECTOR RESTRICTOM ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 1Z ANNWLINTEGRITYTEST(OAGPH) SlICT10WGRAVITV SYSTEM: SUCTIONIGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISLALALARMS ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUALALARMS EMERGENCY GENERATORS ONLY(Chat M Mal apply) EMERGENCY GENERATORS ONLY(CMO aY tlwf appy) 014. CONTINUOUS SUMP SENSOR WTHOUT AUTO PIMP SHUT OFF•AUDIBLE AND E3 14. CONTINUOUS SUMP SENSOR WTHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 1S.AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)WTHOUT FLOW SHUT OFF OR ❑ 1S. AUTOMATIC LINE LEN(DETECTOR(3.0 GPH TEST RESTRK:TION ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPX) ❑ 16. ANNUAL INTEGRITY TEST(OA GPM) ❑ 17. DAILY VISUAL CHECK ❑ 1T. DAILY VISUAL CHECK VM:.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ L CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH UNEP I MONITORING ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WTH AUTO SHUT OFF FDR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑ 6. NONE IX.OWNEWOPERATOR SIGNATURE 1 GINfy tlW NN inbrmaNen p16rINaN 11MM a bus✓M amaMs b V1s Dui d W MIaMeN9a. S gpPEMT DATE EOF R ( lute _ YS AA,OR fL�w I - i P .F PennA NMNpM(fv Nolusa oNyU PMIM Appwe6(Forlpuluis odN T 4 (Fw Lary uu aYN G � l i s 16 Lf Lt a .. CUPAFORM(4/99) FarrneNy SWRCB Form B