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IL <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> [L-7-� <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANKS <br /> VL%PING CONSTRUCTION(�h•ck aU Na[ayply) <br /> UNDERGROUND PIPING _SYSTEM TYPE ❑ 1 PRESSUREAB GROUND PIPING <br /> 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE <br /> CONSTRUCTIOW I. SINGLE WALL El 3, LINED TRENCH 0 9 OTHER ❑ 2. SUCTION ❑ ] GRAVITY <br /> MANUFACTURER 2. DOUBLE WALL ❑95. UNKNOWN SINGLE WALL ❑g5. UNKNOWN <br /> MA FACTURER 2. UBLEWALL <br /> ❑99. OTHER <br /> MANUFACTURER <br /> 1.BARE STEEL ❑ S. FRP COMPATIBLE WI 100%METHANOL <br /> MATERIALS AND ❑ ]. STAINLESS ❑ T. GAWANILE03TEEL 1. BARE STEEL ❑ S.FRP COMPATIBLE Wt I=%ME <br /> CORROSION ❑ 2, STAINLESS STEEL GALVANIZED_ <br /> PROTECTION ❑ 3. PLASTIC COMPATIBLE VATH CONTENTS 095. UNKNOWN ❑ 3. PUSTIC COMPATIBLE WITH CONTENTS ❑ S,FLEXIBLE(OPE)EL <br /> 114. FIBERGLASS ❑ 3. FLEXIBLE(HOPE) 1199, OTHER ❑ 4. FIBERGLASS Cl 99, OTHER <br /> Cl 5. STEELWICOATING ❑ 9.CATHOOICPROTECTION ❑ 9. CATMOOICPROTECTIO.Y <br /> ❑ 5. STEEL WI COATING ❑95. UNKNOWN <br /> NL PIPING LEAK DETECTION(Check a2thaN�pyJ - _ _ <br /> UNOERGROUNp PIPING <br /> SING WALL PIPING ABOVEGROU <br /> PR- BURRED%PING(Cn•c.}aU mM a➢pyF NOPIPING <br /> PRFASURILEO PIPING(Chek aU that• SLYGLE WALL PIPING <br /> I ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST PATH AUTO PUMP SHAT OFF FOR L-J•/ CTO <br /> LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL 1. ELECTRONIC UN'c LEAK DETECTOR IO GPM TEST Ya1TM AUTO PUMP SHUT OFF FOR LEAK, <br /> V✓ALARMS SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AVOISLE AND VISUAL ALARMS <br /> ❑ /.MONTHLY 0.2 GPX TEST ❑�(MONTHLY 02 GPX TEST <br /> ANNUAL INTEGRITY TEST(0 I GPH) ,L'�J//J ANNUAL INTEGRITY TEST(0.1 GPH) <br /> LTJ . pMLY VISUAL CHECK <br /> COI` NTIONAL SUCTION SYSTEMS CO NTIONAL SUCTION SYSTEMS <br /> S DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING IN TEGRI TY 5 GAILY VISUAL MONITORING OF PI NG ANDD PUMPING SYSTEM <br /> TEST(0 1 GPM) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ S. TRIENNIAL INTEGRITY TEST(0j GPX) <br /> ❑ T. SELFMONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOWGROUNO PIPING): <br /> GRAVITY PLO'!! <br /> Cl T. SELF MONITORING <br /> ❑ 9. BIENNIAL INTEGRITY TEST(01 GPM) A GRAVITY FLOW(Cneck n/roar appy).' <br /> ❑ S. DAILY VISUAL MONITORING <br /> ❑ <br /> SECONDARILY CONTAINED PIPING 9. BIENNIAL INTEGRITY TEST(0.1 GPM) <br /> PRES$UR12E0 PIPING(Crus anmu.DONTSECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Cn•c}al/that apply). <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WiTM AUDIBLE ALIO VISUAL AND <br /> 118 AUT) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUALAURMS ANO N,,}coal <br /> ❑ a AUTO PUMP SHUT OFF WHEN q LEAK OCCURS ❑ AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 AUTO PUMP SHUTOFF FOR LEAKS.SYSTEM FAILURE SYSTEM ,�./y <br /> /❑ DISCONNECTION C. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DSCONNECTION i <br /> a NO AUTO PUMP SHUT OFF <br /> 1 AUTOMATIC UNE LEAK DETECTOR(310 GPM TEST)VATH FLOW SHUT OFF OR ,,�❑ c. NO AUTO PUMP SMUT OFF i <br /> / RESTRICTION ,Q/ <br /> 11 AUTOMATICLEAK DETECTOR <br /> 1/2 ANNUAL INTEGRITY TEST IC.i GPM) {A 1].ANNUAL INTEGRITY TEST(O.t GPX) <br /> Su �N`GRAVITY SYSTEM INTEGRITY TEST(O.t GPX) <br /> �hV✓//t]. <br /> CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS SUCT CONTINUOUSNAGRAVTTy SUM; <br /> ❑ 1]. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUALAURMS <br /> EMERGENCY GENERATORS ONLY(C txk apthaNppy) <br /> ❑ i4. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF•AUDIBLE AND EMERGENCY GENERATORS ONLYXC *admv.,y) <br /> VISUALAURMS ❑ IC CONTINUOUS SUMP SENSOR WTHOUi AUTOPUMP SHUT OFF•AUGSLEANp VISUAL <br /> ❑ 13. AUTOMATIC UNE LEAK DETECTOR(].OGPHTEST)WTXOUT FLOWSHUTOFFOR ALARMS . <br /> RE15,A TNI ❑ 15. AUTOMATIC UNE LEAK DETECTOR C3.0 GPM TEST) <br /> ANNUAL INTEGRITY TEST CO.1 GPM) � <br /> 1T.DAILY VISUAL CHECK s+}^ ANNUAL INTEGRITY TEST(0.1 GPX) <br /> 1T. pAILY VISUAL CXECK - <br /> VNL DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT LPI FLOAT MECHANISM THAT SHUTS OFF SMEAR VALVE <br /> DATEINSALTA ❑ 2.CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUALAURMS 4 OMLYMSUALCHECK <br /> a.TRENC <br /> El. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER*AVOISLEANO VISUALAURMS ❑S. NONE HUNERIMONRORING <br /> I eartUy plat ma bmMucn LX OWNERIOPERATOR SIGMA RE <br /> prvrMac Mnin is pV•aeM•CPunb to P•bsl at mY anpvA•Oge. <br /> SIGNATUREO PERATOR <br /> GATE <br /> NAME OF GWNEWOPEMa'aR(prin0 <br /> TITLE OF ERO RATOR <br /> I <br /> Oami4 Nlunp•r(Forpcy va•an/y) P.mu APPrn•0(FwPocal ua•��ry) <br /> P..N Eapua9on Dan!Palos vae aMYI <br /> CUPAFORM(4;99) <br /> F <br />