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FROM : J. Schetter PHONE NO. : 5306667692 Mar. 21 2005 34:54PM P4 UNIFIED YROCxRAM CONSOLIDATED FORM/ TANK UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION ('heck it that mv,210 ABOVEGROUND PIPING UNllERGROUNU PIPINGl GRAVITY 439 SYSTEM TYPE �1.PRFC.SSUAE ©2,SUC-NON ❑3.GRAVITY 458 [3 1.PRESS ❑2. SUCTION ❑,�GRAV462 CONS-lIkUCTloN 1.SINGLE WALL[] ❑3 LMED TRENCH ❑99.OTHER 4600 I.SINGLE WALL ❑95.UNKNOWN p z.DOUBLE WALL O 99,OTHER mAmmcrUREK 0 2.DOUBLE WALL ❑95.UNKNOWN 463 .wt MANUFACTURER MANUFACTURER ❑6.FRP COMPATIBLE Wilw/a METHANOL ❑1,BARE STEEL [_j6.r12P COMPATIBLE W/100% �(FTHANUL ❑1 .BARE Sl'ESL ❑i.GAL.VANI%ED S-I'EEL [�2,STAINLESS S"I'EEL ❑7,GALVANIZIrD STEEL fi ❑uniuOwn 0 2. STAINI ESS STEEL 99, S.[J 3.PLASTIC COMPATIBLE W!CONTENTS Q 99. Other I ❑3. PLASTIC COMPATIBLE W/CONTO 9,CATFIODEiCOTECT]❑ON OILIER FLLE(HDPL-') I El 4, FIBERGLASS �}4.FIBERGLASS ❑3, EXIB []95.UNKNOWN 465 ❑9,CATHODIC PROTECTION 464 ❑5. STEEL WiCOATING L]5,STEEL WJCOATING VII.PIPING LEAIS:DETE('1'ION Chak$11 that aVVIY)(A deacri tion of the ttwnitorie program shalAB OVE(:ROtUNI)PIPING ) TINDERGROUNI)PIPIN(; SINGLE.WALL."fPING 467 SIN(;LE WALL PIPING t(� PRESSURIZED PIPING(Chxkall that apply)' PRESSURIZED PIPING(Check all that apply)' ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 Gp}l'I'EST WITH AUTO PUMP SIiUT ❑ ►. T Q��O LEAK,SYSDTEM FAILUREGAND SYSTEM'DISCONNECTION+ OFF POR LEAK.SYSTEM FAILURE,AND SYSTEM DISCONNECT ION+ AUDIBLE AND VISUAL ALARMS, AUDIBLE-AND VISUAL ALARMS. ❑2. MONTHLY 0.2 GPH TEST ❑2.MONTHLY 0,2 GPH TEST' ❑3.ANNUAL INTEGRITY TEST(O.IGPFI) [13.ANNUAL INTEGRITY TTd$T(0.1Gp1 F) ❑4, DALLY VISUALCII)SCK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION ION SYSTEMS(Chak 411 dwt APPIA ❑S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIGNIN'IAL PIPING ❑5 DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN III-LOW GROUNUPII'ING): ❑6. TRIENNIAL INTEGRITY TEST(0,1 CrPH) SAFE SUCTION SYST1iM4(NO VALVI5 IN BELOW GROUND PIPING): (]7.SELF MONITORING GRAVITY FLOW ❑7. SELF MONITORING ❑9.BMINIAL INTEGRITY TMST(0.1 GPH) GRAVITY FLOW(Check Al that apply); ❑8. DAILY VISUAL MONITORING ❑9. BIENNIAL INTE(IRITY TEST(0,1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply) PRESSURIZED PIPING(Check all that apply). 10. OONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check one) ALARMS AND(Check one) [3a. AUTO PUMP ST'TTJf OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A i.CAK OCCURS ®b. AUTO PUMP SHUT OFF POR LEAKS,SYSTEM FAMURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS.SYSTF..M PAI I_I IRE AND SYSTEM DISCONNECTION DISCONNECTION []c. NO AUTO PUMP SHUT OFF ❑c NO AUTO PUMP SHUT OFF 0 11. AUTOMATIC uNF. F.F.AK DETECTOR(3.0 GPH TEST)WK TFI FLOW SHUT ❑1 I AUTOMATIC:LEAK DETECTOR OFF OR RESTRICTION Q I2. ANNUAL um.GRTTY TEST(0.1 GPH) ❑12. ANNUAL.INTE(,,RITY TEST(0.l GPH) SUCTION/GRAVITY SYSI EM SUCTION/GRAVITY SYSTEM [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAI.ALARMS ❑13 CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENICRATORS ONLY(Chock all that apply) [114. CONTINUOUS SUMP SENSOR Yall=AUTO PUMP SJ4U i OFF a ❑14. CONTINUUMS SUMP SENSOR WITHOUT AUTO PLIMP SHI IT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAI.ALARMS ❑15, AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOI IT FLOW []15. AUTOMATIC LINE I:FAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION ❑16,ANNUAL 1NTEORITY TEST(0.l GPH) [116.ANNUAL,INI'RC;RIT V TEST(0.1 GPH) ❑17. DAILY VISUAL CHECK 1 ❑ 17. DAILY VISU1%C1,1T,.CIC VIII.DISPENSER CONTAINMENT DwrNSER CONTAINMENT ❑ I.FLOAT N EC14ANJSM THAT SHUTS(-)FP SlILAR VALVE ❑4 DAILY VISUAL CHECK DATE INSTALLED 46R ❑2 CONTINUOUS DISPENSER PAN SP.NSOR+AT IDIRLE AND VISUAL ALARMS ©5.TRENCH LINER/MONITORING ®3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO$M IT OFF FOR 0 6.NONE 469 DISPENSER AUDIBLE AND VISUAL ALARMS Ix.OWNER/OPERATOR SIGNATURE I certify that the inf "on vided heroin is true and accurate to the bast of my knowlodpx. M SIGNATURE OF PWAAUOP DATE 470 03/21/2005 NAME OF O OPRATOR(print TITLE OF OWNF?R/OPER ATOR 47; John Sche er Environmenvil Com Bance S ecilist Permit Number( or 1 al use only) 473 Pc-in Appeo-d(For local use only) Permit Hxpiration Date(For local use only) 475