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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VL PIPING CONSTRUCTION(Cdp*a mairappy UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE ❑ 2.SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION ❑ 1. SINGLE WALL a❑aAA 3. UNEOTRENCH ❑99. OTHER ❑ 1. SINGLE WALL EX95. UNKNOWN MANUFACTURER 112 DOUBLE WALL p1 95. UNKNOWN ❑ 2. DOUBLE WALL ❑H.OTHER MANUFACTURER MANUFACTURER 131.BARE STEEL ❑ e. FRP COMPATIBLEWI100%MUT OL ❑ 1. BARE STEEL ❑ S. FRPCCMPATI8LEW lW%METHANOL MAMRIALSAND ❑ 2. STAINLESS STEEL 11 T. GALVANREOSTEEL ❑ 2.STAINLESS STEEL CORROSION .�d ❑ T. GALVANIZED STEEL PROTECTION 133. PLASTICCOMPATIBLEVATH CONTENTS 0995. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WTH CONTENTS ❑ S. FLEKIBLE(HOPE) - ❑99. OTHER ❑ 0. FIBERGLASS ❑ e. FLEXIBLE(HDPE) ❑Be. OTHER ❑ e. FIBERGLASS ❑ B.CATHOMCPROTECTION ❑ 5. STEELWICOATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEELWI COATING W95. UNKNOWN VII.PIPING LEAK DETECTION(Check ad fhafappY) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALLPIPING PRESSURIZED PIPING(Clock all Mal apply): PRESSURIZED PIPING(pleCk ad that appy): ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH 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 GPH TEST 11 3. MONTHLY 02 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST(0,1 GPM) 113.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ k WILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Clock ad Mat apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPINGSYSTEM TEST(0.1 GPM) ❑ S. 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. SELF MONITORING - GRAVITY FLOW GRAVITY FLOW(DlMakadfhet wM9: ❑ e.BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ S. GAILYVISUALMONITORING ❑ 9. BIENNIALINTEGRITYTEST(O.IGPH) SECONDAMLY CONTAINED PIPING PRESSURIZED MPING(Clock ad Met epMA1.' PRESSURIZED PIPING(DAeck am Mail SECONDARILY CONTAINED PIPING UL CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUALALARMS AND (Check aea) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(tlieck orM) ❑ a. AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b AUTO PUMP DISCONNECTION 11 OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b, AUTO PUMP SHUT OFF FOR LEAK$SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONGRAVITY SYSTEM: SUCTIONGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13 CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Clocked mal appy) EMERGENCY GENERATORS ONLY(Clock ad pat eppfy) ❑ 14, CONTINUOUS SUMP SENSOR WITHOUTAUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL VISUAL ALARMS A ARMS ❑ 15.AUTOMATIC LINE LEAN DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15 RESTRICTION! . AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST) ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17.DAILYVISUAL CHECK ❑ 1T. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLEO ❑ 2. CONTINUOUS DISPENSER PAN SENSOR r AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS SIS. NONE IX.OWNERIOPERATOR SIGNATURE I lo111h Mat Marinlerme5an poviEeE MIaN is trw an0 apaxab w 91a s,of my knaNeC9e. SIGNATU OWNER)OPPATOFL. October 4, 2002 Be er Y N.O la TT EOF OWNERgPENATOR President Raymond Investment Corporation Pam@Numbx(FwbW uta aafY) PannN Appmve4(FwlouluM wdyf PxmB Emiratlon Dab(FPrbcal usa wtlN CUPAFORM(4199) k J Formerly SWRCB Form B