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UNIFIED PROGRAM CONSOLIDATED FORM !{U NKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 a- � VL PIPING CONSTRUCTION(Ohacx ad alae appy) UNDERGROUND PIPING .. ABOVEGROUND PIPING SYSTEM TYPE CK PRESSURE 11 2. SUCTION ❑ 0. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 0. GRAVITY CONSTRUCTION ❑ 1 SINGLE WALL ❑ 0. LINED TRENCH ❑99 OTHER ❑ 1. SINGLE WALL - ❑95. UNKNOWN MANUFACTURER DOUBLE WALL ❑95. UNKN WN A ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1 BARESTEEL ❑ 6. FRP COMPATIBLE W/IM%METHANOL ❑ 1. BARE STEEL ❑ 6,FRP COMPATIBLE W/100%METHANOL MATERIALSAND ❑ 2.STAINLESS STEEL 117. GALVANIZED STEEL CORROSION ❑ 2. STAINLESS STEEL 117.GALVANIZED STEEL PROTECTION ,❑ 6]. PLASTIC COMPAT184E WITH CONTENTS ❑95 UNKNOWN 111 FUSTIC COMPATIBLE WITH CONTENTS 136. FLEXIBLE(HOPE) C199, OTHER IG l FIBERGLASS ❑ B. FLEXIBLE(HOPE) 1190, OTHER, ❑ t FIBERGLASS ❑ 9. CATHOOIC PROTECTION ❑ 5 STEEL W/COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑95. UNKNOWN ' VII.PIPING LEAK DETECTION(Check a6 mal appy) SINGLE WALL PIPING UNDERGROUND PIPING ABOVEGROUND PIPING PRESSURIZED PIPING(Cnecx ed loaf appy): PRESSURIZED PIPING(CAaM ad mal appy):SINGLE WALL PIPING ❑ 1. ELECTRONIC LINE LEAK DETECTOR 00 GPM TEST WITH AUTO PUMP SMUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 0.0 GPM TEST WITH AUTO PUMP SMUT OFF FOR LEAK, LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION♦AUDIBLE AND VI SUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2.MONTHLY G2 GPM TEST ❑ 2. MONTHLY 02 GPM TEST ❑ 2 ANNUAL INTEGRITY TEST 10 I GPM) ❑ 0.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ a. DAILY VISUAL CHECK - CO.NVEMiIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Chock ad mat appy): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(01 GPM) ❑ 6. TRIENNIAL INTEGRITY TEST(0.1GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING FLOW 0 9 BGRAVITY FLOW(Chock ad mat appy)', 9 BIENNIAL INTEGRITY iESi101 GPM) ❑ 6. DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GPM) SECONOARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Cha[*ad Tal appfy): PRESSURIZED PIPING(Check eN mal apply). 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUA L ALARMS AND Ceeec/cx ona) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(We"Wa) LJ UTO PUMP SHUT OFFWIIEN A LEAK OCCURS ❑ ..AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 4Vo AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ 9. AUTO PUMP SHUTOFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION 1141 ....��❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF IN'11 AUTOMATIC LINE LEAK DETECTOR(0.0 GPM TEST)WISH FLOW SHUT OFF OR RESTRICTION ❑ 11. AUTOMATIC LEAK DETECTOR 11Y12 ANNUAL INTEGRITY TEST(01 GPM) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) SUN,GRAVITY SYSTEM- SUCTIOR/GRAVITY SYSTEM: CONTINUOUS SUMP SENSOR•AUDIBLEANO VISUAL ALARMS ❑ 15 CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS mV� EMERGENCY GENERATORS ONLY(Check adfAaf appal EMERGENCY GENERATORS ONLY(Chock all mal appy? 14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND ❑ ia. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SMUT OFF•AUDIBLE AND VISUAL ��' VISUAL ALARMS ALARMS L715. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SMUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST) Cello. CT 16. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17, DAILYVISUALCHECK ❑ T7. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ a. DAILY VISUAL CHECK DATEINSTALL D d� ❑ 2. CONTINUOUS DISPENSER PAN SENSOR a AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER/MONITORING V ❑ 6. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑ 6. NONE DL OWNEP/OPERATOR SIGNATURE I Mmy Tal Ta Infpma9on Porided hauin is 9N0 MM of dv b Me Eatl of my MoMa69a. SIGNATURE OF OWNE(LOPERATOR DATE NAME IMOPERATOR rpnnO TITLEOFOWNEWOp�ERAR L w ro .r' Oer25;--T' Pamlil Num9ar(Epi MCN vta pny/ Pam4l AppavM(Forfocal me eNyJ � P* EapYin Data(fal/acal ma onyJ TO0 0 oP 0 llo CUPAFORM(4/99) Formerly SWRCB Form 8