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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VL PIPING CONSTRUCTION(Clack a/DRAT appy) UNOEROROUND%%NG SYSTEM TYPE ❑ 1ABOVEGROUND PIPING . PRESSURE ❑ 2.SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ ]. GRAVITY CONSTRUCNOW ❑ 1. SINGLE WALL ❑ 3. LINEO TRENCH 1199 OTHER ❑ 1. SINGLE WALL ❑0. UNKNOWN MANUFACTURER ❑2. DOUBLE WALL ❑95. UNKNOWN MANUFACTURER 112. DOUBLE WALL ❑0, OTHER MANUFACTURER _ff 1.BARE STEEL ❑ 8. FRP COMPATIBLE WI IN%METHANOL ❑ 1. BARE STEEL MATERIALS AND ❑ Z STAINLESS STEEL ❑ T.GALVANIZED STEEL ❑ S. FRP COMPATIBLE W/100X METHANOL CORROSION ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL PROTECTION ❑ 3. PLASMCCOMPATIBLEN4HCONTENT3 0 UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEKIBLE(HOPE) 13. OTHER ❑ 4. FIBERGLASS ❑ S. FLEXIBLE(HOPE) 1199 OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEELWI COATING ❑ S. CATHODIC PROTECTION ❑ 5. STEEL Wl COATING ❑95. UNKNOWN VU.PIPING LEAK DETECTION(CMck M fMf appy) UNDERGROUND PWING SING WALL%%NG ABOVEGROUND PIPING PRESSURIZED%PING(CMck a/that apply): PRESSURIZED PIPING(CMck a/Pat appM: LEAK,SYSTEM FAILURE,AND SYSTEMM DISCONNECTION SINGLE WALL PIPING - ❑ 1. ELECTRONIC UNE LEAK DETECTOR GPM TEST TION AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK ALARMS •AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDUDIBLE AND VISUAL ALARMS ❑ 2. MONTHLY 02 GPH TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST(0,I GPM) ❑ 3.ANNUAL INTEGRITY TEST(0,1 GPH) ❑ 4. GAILYVISUALCHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(CMck all flat appy): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(01 GPM) ❑ 8. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 11 iSELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): . 11 7, SELF MONITORING GRAVITY FLOW'. ❑ 9 BIENNIAL INTEGRITY TEST to 1 GPM) GRAVITY FLOW(Cbk 0 pat apply)' ❑ 8. DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(0 1 GPM) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(CA ka/Mat appy). SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(CNepk a/par appy): 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL AND )Clea.) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Nock ane) ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a AUTO PUMP DISCONNECTIONT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ 0 AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ p. NO AUTO PUMP SHUT OFF ❑ 1 NO AUTO PUMP SHUT OFF ❑ 11 AUTOMATIC UNE LEAK DETECTOR f3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ it AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12 ANNUAL INTEGRITY TEST 10.1 GPM) ❑ 12.ANNUAL INTEGRITY TEST(0 1 GPM) SUCTIOWGRAVITY SYSTEM'. SUCTION/GRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR•AUOISLEANO VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Clack a/Nor appy) EMERGENCY GENERATORS ONLY(CMck A/Nat apply) ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMPSHUTOFF•AUDIBLE AND ❑ ta. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15.AUTOMATIC UNE LEAK DETECTOR(00 GPM TEST)WITMOUT FLOW SHUT OFF OR ❑ 15. RESTRICT;ON AUTOMATIC LINE LEAK DETECTOR(30 GPX TEST) ❑ 18.ANNUAL INTEGRITY MST(0 1 GPM) ❑ 18.ANNUAL INTEGRITY MST(0 1 GPM) ❑ 1T. CMLYVISUALCHECN ❑ 17. DAILY VISUAL CHECK VRI.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILYWSUALCHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WTH AUTO SMUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS biz-6. NONE UL OWNER/OPERATOR SIGNATURE I ca151)'ha[Ne 68amaWn prwka4 Mian is OVe aM aCWraa b 51a brt pl my MnPMaa2a. SIG9U EOF ERIOPERA DAA a - - O NAME OF GWNERAOPERA (OHIO TITLE OF EILOPERATOIr Pamvr NumYr(FarbcN uta only) PartNIAppIRkH(iwkglPae alpYl Pemul EapkaePnDM(FwkNal vaa ar/k9 CUPAFORM(4199) `, Formerly SWRCB Form 8