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UNIFIED PROGRAM CONSOLIDATED FORM O I S Z �..✓` <br /> �Ut✓ TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(CAackatlwrapply ct <br /> UNDERGROUND PIPING <br /> ,a, � ABOVEGROVNO PIPING <br /> SYSTEM TYPE M PRESSURE ❑ 2. SUCTION ❑ 3 GRAVITY ❑ 1. PRESSURE <br /> ❑ 2. SUCTION ❑ ]. GRAVITY <br /> CONSTRUCTIONI _❑ 1 SINGLE WALL ❑ 3. LINED TRENCH ❑99 OTHER 131. SINGLE WALL 1195. UNKNOWN <br /> MANUFACTURER LyZ pOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER <br /> MANUFACTURER /1 A tOi A • i <br /> MANUFACTURER <br /> ❑ 1.BARE STEEL -` ❑ e. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ S. PAP COMPATIBLE An 100%METHANOL <br /> MATERIALSAND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7.GALVANIZED STEEL <br /> CORROSION ' <br /> PROTECTION ❑ LASTIC COMPATIBLE W TH CONTENTS 1195 UNKNOWN 11 ]. PLASTIC COMPATIBLE WITH CONTENTS ❑ 5.FLEXIBLE(HOPE) ❑99. OTHER <br /> t FIBERGLASS ❑ 9. FLEXIBLE(HOPE) 1199. OTHER, ❑ t. FIBERGLASS ❑ 9, CATHOOIC PROTECTION <br /> ❑ 5. STEELWICCATING ❑ 9.CATHOOIC PROTECTION ❑ 5. STEEL VA COATING 1195. UNKNOWN <br /> VII.PIPING LEAK DETECTION(CMckan MjHopply) <br /> SINGLE WALL PIPING UNDERGROUND PIPING ABOVEGROUND PIPING <br /> PRESSURIZED PIPING(GAAP*1Y Itala SINGLE WALL PIPING <br /> ➢ANF PRESSURIZED PIPING(Cock atl Naf epplyJ: <br /> ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK. <br /> LEAK,SYSTEM FAILUP E.AND SYSTEM DISCONNECTION.AUDI BLE AND VISUAL SYSTEM FAILUR E.AND SYSTEM DISCONNECTION.AUOIBLE AND VISUAL ALARMS <br /> ALARMS 112. MONTHLY 0.2 GPM TEST <br /> 11 3. MONTHLY 42 GPM TEST <br /> ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) <br /> C] 3.ANNUALINTFGRITYTEST(0.1 GPM) <br /> ❑ t. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check atl Nal apply): <br /> ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> - <br /> TEST 101GPM) ❑ 9. TRIENNIALINTEGRITYTEST(0.1GP1) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN SELOW GROUND PIPING)t SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> El 7 SELF MONITORING <br /> ❑ 7. SELF MONITORING <br /> GRAVITY FLOW <br /> GRAVITY FLOW(Check an that apply):! <br /> C1 9 BIENNIAL INTEGRITY TEST lO1GPM) ❑ a. DAILY VISUAL MONITORING <br /> ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING ILAKk an Nal apply)' PRESSURIZED PIPING(CXack a WXar appyf: <br /> 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br /> IC�cjYaml 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(mock one) <br /> Lriiv6 AUTO PUMP SMUT OFF WHEN A LEAK OCCURS C3 a.AUTO PUMP SMUT OFF WHEN A LEAK OCCURS <br /> uAUTO PUMP SHUT OFF FOR LEANS.SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION ❑ G, AUTO PUMP SHUTOFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION <br /> ❑ c NO AUTO PUMP SHUT OFF ❑ c NO AUTO PUMP SMUT OFF <br /> n AUTOMATIC LING LEAK DETECTOR(00 GPM TEST)WITH FLOW SHUT OFF OR <br /> 19 ESTRICTION ❑ 11. AUTOMATIC LEAK DETECT00. <br /> LJFUT ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) <br /> 0 CO MORAVITY SYSTEM SUCTIONGRAVITY SYSTEM: <br /> 13 CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 13 CONTINUOUS SUMP SENSOR.AUDIBLE ANO VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check as Olal apply) EMERGENCY GENERATORS ONLY(Chock an Nal apply <br /> N14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ IC CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL <br /> VISUAL ALARMS ALARMS <br /> 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(].O GPM TEST) <br /> RICTION <br /> A.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ id.ANNUAL INTEGRITY TEST(0.1 GPM) <br /> O. DAILT VISUAL CHECK ❑ 17. DAILY VISUAL CHECK <br /> VIIL DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ A DAILY VISUAL CHECK <br /> ATE INS LLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR♦AUDIBLE AND VISUAL ALARMS 135. TRENCH LINER I MONITORING <br /> ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ 9.NONE <br /> I)L OWNERIOPERATOR SIGNATURE <br /> 1 caviar mal Ns Nlannalan pmviBaO NnIn ie"a and accunM X*Gut OI my knorAa09a. <br /> SIGNATURE OF OWNENOPFNATOR UATE <br /> NAME OF DWNE PERATOR Ipdn0 /�- TITLE OF OWNEF.OPERA_TO/R <br /> f�C <br /> Parma Number(Farlocalu..PNy Pamu1 AppmvaB fFwMcal uaa P^lY) Parma Eep4aY00D e(FcrAkdI Ina Inky) <br /> p`rooC, 9 <br /> CUPAFORM(4199) <br /> Formerly SVVRC8 Form 0 <br />