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I � UNIFIED PROGRAM CONSOLIDATED r SRM ::S] UNDERGROUND STORAGE TANKS -TANK PAGE 2 Paste, of ,y VI. PIPINGCONSTRUCTION(Ch ick alt lFa �P lY)_. �_. . UNDERGROUND PIPING AGOVE6ROUND PIP IPTG SYSTEM TYPE 69,11.PRESSURE r 2. SUCTION 1-3. GRAVITY r 1. PRESSURE 1-2. SUCTION ]'a GRAVITY 459 CONBT'RUCTION, r 1.SINGLE VALL ]'3. LINED TRENCH r99. OTHER r 1. SINGLE WALL r95. UNKNOWM 1152 MANUFACTURE DOUBLE WALL r95. UNKNOWN r 2. DOUBLE HALL r99. OTHER R MANUFACTURER 161 MANUFACTURER 463 r 1.BARE STEEL r S. FRP COMPATIBLE W 1(30%METHANOL r I. BARE STEEL r A FRP COMPATIBLE W 100.6 METHANOL MATERIALS ANO ]"'2 STAINLESS STEEL r 7. GALVANIZED STEEL r 2. STAINLESS STEEL r 7. GALVANIZED STEEL CORROSION PROTECTION 1-3.PLASTIC COMPATIBLE NTH CONTENTS r95. UNKNOWN r3. PLASTIC COMPATIBLE WTHCONTENTS rB FLEXIBLE(HOPE) r99. OTHER 4 FIBERGLASS r S FLEXIBLE(HDPE) r99. OTHER r 4. FIBERGLASS r 9. CATHODIC PROTECNON r a STEEL W COATNG r S. CA7MDICFROTECTON 464 1-S. STEEL W COATING r95. UNKNOWN 165 UNDERGROUND UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 46/ PRESSURIZED PIPING(Ch.&a/that apply): PRESSURIZED PIPING(Check all that apply): r 1. ELECTRONIC LINE LEAK DETECTOR 30 GPH TEST WIT AUTO PUMP SHUT OFF FOR r 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST 1W T AUTO PUMP SHUT OFF FOR LEAK LEAK SYSTEM FAI.URE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ALARMS r Z. MONTHLY0.2GPHTEST r 2. M0NTHLYO.2GPHTEST r 3. ANNUAL NTEGRTTYTEST(O.I GPM r 3. ANNUALINTEGRRYTEST(0.1 GPH) r 4 DMLY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check a/I that apply): Ir 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY r 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) r G. TRIENNIAL INTEGRITY TEST(mi GPH) SAFE SUCTION SYSTEMS(NO VALVES N BELOWGROUND PIPINGY SAFE SUCTION SYSTEMS(NO VALVES W BELOW GROUND PIPINGk r 7. SELFMONRORING r 7. SELFMONITORING GRAVITY FLOW GRAVITY FLOW(Chet all Nat apply): r 9. BIENNIAL INTEGRIfYTEST(O.i GPH) r B. DARYVLSUAL MONITORING r 9. BIENNIAL INTEGRTIYTEST(0.1 GPH) SECONDARILY CONTAINED NED PIPING NGSECONDARILY CONTAINED PIPING PRESSURIZED PIPING tapp/N: PRESSURIZED PIPING(Check aNthat apply: 10. (Che k me) 5 TURBINE SUMP SENSOR NTH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WTH AUDIBLE AND VISUAL ALARMS AND(rhetic me) r a AUTO PUMP SHUT OFF INHEN A LEAK OCCURS r a.AUTO PUMP SHUT OFF VWHEN A LEAK OCCURS D. UMP P AUTO SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM SIGN I-b. AUTO PUMP SHUT OFF FOR LEEKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION PUMP r c. NO AUTO RUMP SHUT OFF r e NO AUTO PUMP SHUT OFF 5z 11. AUTOMATIC LIVE LEAK DETECTOR(SO GPH TEST)Wf FLOW SHUT OFF OR ] 11.AUTOMATIC LEAX DETECTOR RESTRICTION r 12 ANNUALINIEGRRYTEST(0.1GPH) r 12.ANNUAL INTEGRrrYTEST(0.1 GPH) SUCTIOWGRAVITY SYSTEM: SUCTIOWGRAVITY SYSTEM: r 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS r 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUALALARMS EM ERGENCY GENERATORS ONLY(Cheri aN Met apply) EMERGENCY GENERATORS ONLY(Cheek aA Nat apply) r 14. CONTINUOUS SUMP SENSORWTHOUT AUTO PUMP SHUT OFF.AUDIBLE AND 1-14. CONTINUOUS SUMP SENSOR WTHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUAL ALARMS ALARMS r 15 AUTOMATIC LINE LEAK DETECTOR(&.0 GPH TEST)NTHOUT FLOWSHUTOFFOR r 15.AUTOMATIC LINE LEAK DETECTOR(10 GPH TEST) RESTRICTION I 16. ANNUAL INTEGRITY TEST(Dt GPM r 16. ANNUAL INTEGRITY TEST(0A GPH) 17. DAILYVISUAL CHECK r 17. DAILY VISUAL CHECK VIII.DISPENSER�_O._ )ISPENSER CONTAINMENT r 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 1-4. DAILY VISUAL CHECK DATE INSTALLED 465 1-2 CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS r 5. TRENCH LINER I MONITORING 3. CONTINUOUS DISPENSER PAN SENSOR WTH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS rS. NONE 469 ... .".IX OWNFR/OPERATOR SIGN'_ t 0 a cenily that the lnfomatbn provided herein R me and accurate to the best of my 1,w Hedge. SIGMA ERATO DATE 470 471 - --- v 472 JZPermit Number(Forlocal use mly) 473 "'"'Pprovetl cal vse only) \� 4 Permit Expim4nData(Fcrkcalusecnly) 9]5