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UNIFIED PROGRAM CONSOLIDATED FORM , TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 ( Paaa a 3 VI.PIPING CONSTRUCTION(Clod so"appy) UNDERGROUND PIPING I ABOVEGROUND PIP W G CSYSTEM TYPE ❑ f. PRESSURE 2. SUCTION ❑ 3. GRAVITY 1rI. PRESSESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 459 CONSTRUCTIOW❑ 1, SINGLE WALL ❑ 3. LINEDTRENCH ❑99, OTHER 4GLE WALL ❑93. UNKNOWN 462 MANUFACTURER 2. DOUBLE WALL ❑95. UNKNOWN UBLE WALL ❑99. OTHER MANUFAL RW 4MANUFACTURER1.BARE STEEL O 1-6. FRP COMPATIBLE W/100%METHANORE STEEL ❑ a. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL AINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION ❑ 3. PLASTIC COMPATIBLE WTI CONTENTS ❑9S. UNKNOWSTIC COMPATIBLE WITH CONTENTS ❑ S. FLEXIBLE(HOPE) ❑N. OTHERPROTECTION ❑ 4. FIBERGLASS ❑ S. FLEXIBLE(HOPE) ❑99. OTHER . ERGLASS 119, CATHODIC PROTECTION ❑ S. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464 ❑ 5. STEEL W/COATING ❑95. UNKNOWN 465 VII.PIPING LEAK DETECTION(CMckAr#*app KI } 4;"Y - •- UNDERGROUND PIPING ABOVE (PING i ' SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Chad a that appy): PRESSURIZED PIPING(Check off MM 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 EM AUTO PUMP SHUT OFF FOR LEN( LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL ALARMS ALARMS ❑ Z. MONTHLY 02 GPH LEST ❑ 2. MONTHLY 02 CPM TEST 113. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check a6 Slot Aptly): ❑ S. DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) ❑ 6. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' 11 1, SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW: GRAINY FLOW(Chop of MN apply); ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ S. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Chep a9 Mat appy): PRESSURIZED PIPING(Chad a/that appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Chad, (Chep Ole) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS �) C3 a. AUTO PMP SNOT OFF WHEN A LEAN(OCCURS ❑ D. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ S. 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 LIKE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11. AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) SA,U{CTIOWGRAVITY SYSTEM: W 17. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS SUCTIONIGMVITY SYSTEM: I` ❑ 11 CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check 80 Nat&A*) '❑ 14. CONTINUOUS SUMP SENSOR WM40UT AUTO PUMP SHUT OFF.AUDIBLE AND EMERGENCY GENERATORS ONLY(Chook 0 MN appy) VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WWTHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ❑ IS.AUTOMATIC LINE LEAK DETECTOR(].0 GPM TEST) ROW SHUT OFF OR ALARMS RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ tS. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ❑ 2. CONTINUOUS DISPENSER PµSENSOR•AUDIBLE AND VISUAL ALARMS S. TRENCH LINER)MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSORTM AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS 6. NONE 409 IX OWNER/OPERATOR SIGNATURE I CM6y H WI9e MtIXmanM pfOWea7 hNNn N Uw,alk aCMie to bee a My 9MMe09e. 51GNA�ERgPf[U OR DATE a- I - o r, 416 R OF OWNER OPEIM�T Rl!( 471 TITLE OF OWNEROOPERATOR V 472 Pelml NumOv( bee V4e aHyl 473 P4Im1 Approae(Far bat uae wW/ 474 P4alml Exp atkn Data(Fvr bol ufe Prvy1 475 UeCF(1/99) Formerly SWRCB Form B r