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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 UNDERGROUND PIPING W.PIPING CONSTRUCTION(Chockak Mnappy) ABOVEGROUND PIPING SYSTEM TYPE 13pRE55URE 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ONSTRUCTIONI 1. SINGLE WALL ❑ 3. LINED TRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑95. UNKNONTI MANUFACTURER ❑ 2. DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER 1.BARE STEEL ❑ S. FRP COMPATIBLE W/1W%METHANOL ❑ 1, BARESTEEL ❑ 6. FRPCOMPATI8LEW/100%MERIANOL MATERIALSAND ❑ 2, STAINLESSSTEEL ❑ T, GALVANIZED STEEL CORROSION ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL PROTECTION ❑ 3. PLASTIC COMPATIBLE WTH CONTENTS 1195. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ B.FLEXIBLE(HOPE) ❑99. OTHER ❑ A FIBERGLASS ❑ 8. FLEKIBLE(HDPE7 1199. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEELW/COATING ❑ 9. CATHODIC PROTECTION 10 5. STEELWICOATING ❑95. UNKNOWN VII.PIPING LEAK DETECTION fchw aMatappy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(CMM adthot appy): PRESSURIZED PIPING(DMCk ad Met appy): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 30 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 ❑ 2.ANNALINTEGITYPH TESEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIOML SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Chock ad tat appy): C15. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST IDA GPH) ❑ S. TRIENNIALINTEGRITYTEST(DIGPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ Z SELFMONITORING ❑ i. SELF MONITORING GRAVITY FLOW. GRAVITY FLOW(CMckad Mat appy): ❑ 9. BIENNIAL TEST(0.1 GPM) ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Choc*aNthat appy): PRESSURIZED PIPING(Check all Mal appy): 10. CONTINUOUS TURBINE SUMP SENSOR VATH AUDIBLE AND VISUAL ALARMS AND (Check oho) 10.CONTINUOUS TURBINE SUMP SENSOR HATH AUDIBLE AND VISUAL ALARMS AND(Aleck oho) ❑ e. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b AUTO PUMP T OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ t NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC UNE LEAK DETECTOR(BD GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ H. gUTOMATC LFAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST JO 1 GPH) ❑ 12. ANNUAL INTEGRITY TEST(0.1GPH) SUCTIOWGRAVITY SYSTEM: SUCTIOWGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check as Mat appy) EMERGENCY GENERATORS ONLY(Chock an Matappl» ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDI BLE AND VISUAL VISUALALARMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOWSHVT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16. ANNUAL INTEGRITY MST(0,1 GPH) ❑ 1T. DAILYWSVALCHECK ❑ 17. DAILY VISUAL CHECK VIII,DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILYVISUALCHECK DATEBISTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING N /(\T_ ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS B. NONE IX OWNERIOPERATOR SIGNATURE I nit4y Mat Me inlwmaeon prmMeE ani.ie Mta aM...w b Me ben 0 lMcoml pe. SIGNATURECFOWNERIOPERATOR DATE NAME OF OWNEWOPERATOR(prad) TITLE OF OWNEWOPERATOR Pwm4 Number(Forlocal uN Dory/ Permit AppovN(Fw ha:al uas ally) ParmM1 Expibllpn Dab(Fwbtal uts oN19 CUPAFORM(4/99) *Ai F000edy SWRCB form 8