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i U NI FIEO PROGRAM CONSOLIDATED FORM TANKS ) UNDERGROUND STORAGE TANKS -TANK PAGE 2 N.PIPING CONSTRUCTION lCMNCHYIMI applN UNDERGROUND PIPING ASOVEGROUNO PIPING $YSTCM TYPE ❑ t PRESSURE ❑ L SUCTION ❑ 0. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ ]. GRAVITY CONSTRUCTIOW ❑ 1. SINGLE WALL ❑ 1 UHEO TRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑9S UNKNOWN MANUFACTURER ❑ L DOUBLE WALL 3395 UNKNOWN ❑ L DOUSLEWALL ❑99.OTHER MANUFACTURER MANUFACTURER L BARE STEEL ❑ B. REP COMPATIBLE Nv 100%METHANOL ❑ 1. BARE STEEL ❑ S. FRP COMPATIBLE Wt 100%METHANOL MATERIALS ANO ❑ L STAINLESS STEEL ❑ T.GALVANIZED STEEL ❑ L STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION C1LA PROTECTION ]. PSOC COMPATIBLE WITH CONTENTS 095. UNKNOWN ❑ ]. PLASTIC COMPATIBLE VAf11 TE CONNTS [3B. FLEIUBLE(HDPE) ❑99. OTHER ❑ a. FIBERGLASS ❑ 0. REOBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 9.CATHODIC PROTECTION ❑ 5. STEELW/COATING ❑ S. CATHODIC PROTECTION ❑ S. STEELWp COATING 095. UNKNOWN VIL PIPING LEAK DETECTION(MEATY~.PPM UNDERGROUND PIPING ABOVEGROUNO PIPING SINGLE WALL PIPING SINGLE WALLPIPING PRESSURIZED PIPING(CAeCA aoBw aAPM: PRESSURIZED PIPING(CNam Aa HaPtaxly): ❑ 1 ELECTRONIC UNE LEAK DETECTOR 0.0 GRI TEST IMTM AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LUNE LEAK DETECTOR 0.0 GPH TEST W1TM AUTO PUMP SHUT OFF FOR LEAK, LEAK.SYSTEM FAILURE AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL SYSTEM FNLURE AND SYSTEM DISCONNEGDON;AUDIBLE AND VISUAL ALARMS ALARMS ❑ TEST L MONTHLY 0.2 GPM TEST [3L MONTHLY 0.2 GRI ❑ ]. ANNUAL INTEGRfTY TEST(0.1 GPM) ❑ ]. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ a. GAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(fJ*cM 0IMf appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ S. GAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPO ❑ B. TRIENNIAL INTEGRITY TEST IDA GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUNO PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7 SELF MONITORING ❑ T. SELFMONTTORING GRAVITY FLOW GRAVITY FLOW(CMrd Al'fNf appy: ❑ 3. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ B. GAILYVISUALMONITORING ❑ 9. 91ENNIALINTEGRITYTEST(O.IGPH) BECONOARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(CMDF M IMI appy): PRESSURIZED PIPING(GNPs V IAM apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND oU10 CONTINUOUS TURBINE SUMP SENSOR VATM AUDIBLE AND VISUAL ALARMS ANO(Ula oral CNNTI ❑ A. AUTO PUMP SMUT OFF WHEN A LEAK OCCURS ❑ A. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ 0. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ B. AUTO PUMP SHIT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ C NO AUTO PUMP SHUT OFF ❑ e NO AUTO RUMP SHUT OFF ❑ 11 AUTO ATION NE LEAK DETECTOR(0.0 GPH TEST)WTH FLOW SHUT OFF OR El 11. AUTC)"TIG LEAK DETECTOR REST❑ t2. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12 ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIOWGRAVIr SYSTEM: SUCTTOWGRAVITY SYSTEM' ❑ t]. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 11 CONTINUOUS SUMP SENSOR-AUOIBLEANO VISUALALARMS EMERGENCY GENERATORS ONLY(CAMAY Mat app'M EMERGENCY GENERATORS ONLY/GNCIr as BNf app" 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL VISWALALARMS ALARMS ❑ 15.AUTOMATIC UNE LEAK DETECTOR(].0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC LINE LEAK DETECTOR(].0 GPM TESTI RESTRICTION ❑ 19.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 16 ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. ONLYVISUALCHECK ❑ IT. DAILY VISUAL CHECK VIII.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 VISUALALARMS ❑ S. TRENCH LINER U MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑ 6. NONE IK OWNERMPERATOR SIGNATURE CMfymtINe miwma P wNaraH1n Rua atN arnrae NON owo(my anoMW9e. S RK)PERAT DATE ,Z (; i T C ME OG R(pMlj_ TCLTLE F I FAATOR Pa1mH Numaaf(For lO<y ux NWl 1 PwmtpppfP'Ii0(fwbcal use P�Wl f P DirLfFFor 1M'1 ki Ili 1 CUPAFORM(4199) FOTmeAy SWRCS FOOD 8