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RE(;I=►v t:v <br /> OCT 2 6 2016 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANKS- TANK P��69ONM `j HEAL H <br /> VI.PIPING CONSTRUCTION c .Il nat• I P.s•�ef <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE ��0'' L PRESSURE �.SUCTION ❑3.GRAVITY 4M ❑1.PRESSURE �.Z SUCTION ❑I.ORAVI7Y •So <br /> CONSTR(K:I(ON.U.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 666 .BINDLE WALL �. 95.UNKNOWN 6R <br /> MANUFACINRER 0 2.DOUBLE WALL 0 95.UNKNOWN G 2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER N CfVG 461 MANUFACTURER 461 <br /> 0 1.BARE STEEL 0 6.FRP COMPATIBLE w/l00% MBiIUNOL 0 1.BARE STEEL ❑6.FEE COMPATIBLE Wrl O ME7NAhUL <br /> ❑2.STAINLESS STEEL 4 GALVANIZED STEEL �UOlmowo 0 2.STAINLESS STEEL ❑7.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPATIBLE W/CONTENTS 0 99. Otha 0 3. PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEIBLE(HDPE) 0 99.OTHER <br /> 0 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) 04. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATINO 0 9.CATHODIC PROTECTION 464 0 5.STEEL W/COATINO 0 95.UNKNOWN 465 <br /> VIL PIPING LEAK DETECTIONce a•u"l. Aa...,l am ofuK,oedbne mm b•.eadm6wav q•.I• <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING SINGLE WALL PIPING 667 <br /> PRESSURIZED PIPING(Call mat•pplyp PRESSURIZED PIPING(C JI wt apply): <br /> 0 1.ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST MM AUTO PUMP SHUT 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST PILQt AUTO PUMP <br /> OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK SYSTEM FAILURE;AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> (:12.MONTHLY 0.2 OPH TEST /J 02.MONTHLY 02 OPH TEST '� / ,7 <br /> 0 3.ANNUAL INTEGRITY TEST(0.1 OPH) j�' 0 3.ANNUAL INTEGRITY TEST(0.1 OPH) / A <br /> []4. DAILY VISUAL CHECK //` // <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(CNet w"'.'1y) <br /> ❑ <br /> S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> WITIGRTTY TEST(0.1 OPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPfPING): 0 6.TRIENNIA.INTEGRITY TEST(o.I OPT{)- <br /> 0 7,SELF MON701UNG SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ' <br /> GRAVITY FLOW 07. SELF MONITORING _ <br /> 0 9.BIENNIAL INTEGRITY TEST(0.1 OPH) GRAVITY FLOW(rv....•II wt appy): <br /> 0 S. DAILY VISUAL MONITORING <br /> 0 9. BIENNIAL INTEGRITY TEST(0.1 DPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Cart W mn•pplyy PRESSURIZED PIPING(Onct all abt apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR MM AUDIBLE AND VISUAL I0. CONTINUOUS TURBINE SUMP SENSOR]yll}I AUDIBLE AND VISUAL <br /> ALARMS AND(O,acbene) ALARMS AND(Ch..) <br /> 0• AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0•AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PtW SHUT DISCONNECTION OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION <br /> 0p.NO AUTO PUMP SHUT OFF 0e NO AUTO PUMP SHUT OFF <br /> 0 11.AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST)WI 7II FLOW SHUT 0 11,AUTOMATIC LEAK DETECTOR I <br /> OFF OR RESTRICTION <br /> 012. ANNUAL INTEORTTY TEST(0.1 OPH) s, )m 0 A) <br /> 12.ANNUALTEORITYTEST(O.i OPH) 7`f <br /> SUCTION/GRAVITY SYSTEM b I SUCDON/GRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUALA <br /> EMERGENCY GENERATORS ONLY(Chit JI u ,-Wy) EMERGENCY GENERATORS ONLY(Chock JI"tapply) <br /> [114.CONTINUOUS SUMP SENSOR WITH iI AUTO PUMP SHUTOFF• 0 14. CONTINUOUSUDIBLE SUMP <br /> SE ALARMS <br /> AUTO PUMP SHUT OFF <br /> MS <br /> AUDIBLE AND VISUAL ALAR <br /> 0.15..AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST)WITHOUT FLOW 0 I5.AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST) <br /> SHUT OFF ORItESTBUCTION <br /> ❑16.ANNUAL INTEGRITY TEST(0.1 OPH) 0 16.ANNUAL INTEGRITY TEST(0.1 OPH) <br /> ❑17.DAILY VISUAL CHECK [317.DAILY VLSUALCHECK <br /> VOL DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 0 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4.DAILY VISUAL CHECK <br /> DATE INST D 66e 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 5.TRENCH LINER/MONITORING <br /> 0 3.CONTINUOUS DISPENSER PAN SENSOR MIN AUTO SHUT OFF FOR 0 6 NONE AM <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> 1'.*"lta bdom•um haaio is tNc aad aocbab blha bur efmybbwldsn 410 <br /> IGNAT"-p6'P DATE <br /> / O PERATO� _ 6R <br /> t <br /> PumhN bcJ uae my) <br /> 673 Pam4ApP^e•66abduamM IN PrmitP�uuim Gab m eas mly) 675 . <br /> UPCF(17199 revised) 12 Formerly SWRCB Form B <br />