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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Check aq Naf appy) <br /> UNDERGROUND PIPING - <br /> A VEGROUND PIPING <br /> SYSTEM TYPE ❑ 1. PRESSURE <br /> ]. SUCTION ❑ ]. GRAVITY ❑ 1. PRESSURE 2. SUCTION ❑ ] GRAVITY <br /> CONSTRUCTIOW ❑�.,/,/, SINGLE WALL ❑ ]. LINED TRENCH ❑99 OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN <br /> MANUFACTURER ] DOUSLEWALL 1195. UNKNOWN lV1 <br /> 2. DOUBLEWALL ❑99. OTHER <br /> MA FACTURER MANUFACTURER <br /> 1.BARE STEEL ❑ 8. FRP COMPATIBLE WI 100%METHANOL I. BARE STEEL ❑ !, FRP COMPATIBLE Wf 1C0%METHANOL <br /> MATERIALS AND ❑ 2. STAINLESS STEEL ❑ T.WLVANgED STEEL ❑ 2. STAINLESS CORROSION ❑ T. GALVANIZEOSTEEL <br /> PROTECTION ❑ ].PLASTICCOMPATISLEWTHCONTENTS 095. UNKNOWN ❑ ]. PLASTIC COMPATIBLE WITH CONTENTS ❑ S. FLEXIBLE(MDPE) ❑99. OTHER <br /> ❑ /. FIBERGLASS ❑ 5. FLEXIBLE(HDPE) 099. OTHER ❑ A. FIBERGLASS ❑ B. CATHODIC PROTECTION <br /> ❑ 5. STEELW/COATING ❑ S. CATHODIC PROTECTION ❑ 5. STEELWICOATING C1 95. UNKNOWN <br /> VIL PIPING LEAK DETECTION(GaekaOMafappy) - - <br /> UNDERGROUND PIPING <br /> SINGLE WALL PIPING ABOVEGROUND PIPING <br /> PR SURIZEO PIPING(Chaok ad that apply): PRE VRIZED PIPING(Chook ad Nat appy);SINGLEWALLPIPING <br /> 1. ELECTRONIC LINE LEAK DETECTOR DO GPM TEST PATH AUTO PUMP SHUT OFF FOR 1. ELECTRONIC LINE LEAK DETECTORS GPM TEST WITH AUTO PUMP SMUT OFF FOR LEAK, <br /> LEAK.SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION.ADDIBLE AND VISUAL ALARMS <br /> ALARMS <br /> ,❑.,/) MONTHLY 0.2 GPM TEST ❑/Z MONTHLY 02 GPM TEST <br /> lL ],ANNUAL INTEGRITY TEST III I GPM) �LS/ANNUAL INTEGRITY TEST(0.1 GPM) ' <br /> a. O ILY VISUAL CHECK <br /> CCN NTIDNAL SUCTION SYSTEMS CO NTIONgL SUCTION SYSTEMS(Check a9Naf appy): <br /> 5 DAILY VISUALMONITORINGOF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY 5 DAILY VISUAL MONITORING OF PIPING AND PUMPINGSYSTEM <br /> TEST to 1 GPM) ❑ 5. TRIENNIAL INTEGRITY TEST(0,1 GPM) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> ❑ T SELF MONITORING <br /> ❑ T. SELF MONITORING <br /> GRAVITY FLOW <br /> ❑ <br /> GRAVITY FLOW(Chaok all mat apply).apply).9. BIENNIAL INTEGRITY TEST IDI GPM) <br /> ❑ <br /> S. DAILY VISUAL MONITORING <br /> ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) <br /> PRESSURIZED CONDARILY PIPING UxFla Mat appy!' SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Chxk all that <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br /> (Coach pool 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(NecF ane) <br /> ❑ AUTO PUMP SHUT OFF AMEN A LEAK OCCURS ❑AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM 0/ <br /> O'SCONNECTION / p AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DSCONNECTION <br /> 01 c NOAUTO PUMP SHUTOFF I <br /> TCG. NO AUTO PUMP SHUT OFF <br /> AUTOMATIC UNE LEAK DETECTOR(10 GPM TEST)WiN FLOW SHUTOFF OR la AUTOMATIC LEAK DETECTOR <br /> RESTRICTION <br /> 12 ANNURLINTEGRITY TEST IO.I GPMJ 12 ANNUAL INTEGRITY TEST(0.1 GPM) <br /> 5@iIGRAVITY SYSTEM: SUCTIONIGRAVITY SYSTEM10 : <br /> 13 CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Chock Athat apply) EMERGENCY GENERATORS ONLY(Clack 09 Mat appy) <br /> ❑ ta,CONTINUOUS SUMP SENSOR yATHOUT AUTO PUMP SHUT OFF.AUDIBLE AND <br /> VISVALALARMS El 14, CONTINUOUS SUMP SENSOR WTHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL <br /> ALARMS <br /> ❑ 15. AUTOMATIC LINE LEAK DETECTOR(].0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR(0.0 GPM TEST) <br /> RESTRI TON <br /> ❑ 1B ANNUAL INTEGRITY TEST III 1 GPM) ❑ f . ANNUAL INTEGRITY MST(0.1 GPM) <br /> T. WILY VISUAL CHECK 1i. DAILY VISUAL CHECK <br /> VHL DISPENSER CONTAINMENT - -DISPENSER CONTAINMENT QrI FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVEa, WILY VISUALCXEp( <br /> DATEINSTALLED ❑ 2.CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING <br /> 13. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑B.NONE <br /> IX.OWNERIOPERATORS NATURE <br /> 1 uNy mat Na N 4pn pmviEaE penin is WunO amrab b ma pas!Of my knpnlaege. <br /> SIGNP RATOR DATE <br /> Ig I oij <br /> NAME OF CNNER/OPERATOR 'c_� TITLE FOWN ROPERATOR 1 <br /> Panni!Numpo(fwbcN vas pny) P it Appfovoe(£Prfacal ma prny) <br /> Pamtit Elrpvatlgn Data pWbul uas wty) <br /> CUPAFORM(4199) <br /> Formerly SWRCB Form B <br />