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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANKS UNOERGflOUND PIANO VL PIPING CONSTRUCTION(CAeck•p NalappW _ 232. SYSTEM TYPE OVEGRGUNO PIPING ❑ I. PRESSURE � Z. SUCTION 11 ]. GRAVITY ❑ 1. PRESSURE CONSTRUCTIOw 11 L SINGLE WALL ❑ ]. LINED TRENCH 2. SUCTION 11 3, GRAVITY MANUFACTURER V2. DOUBLE WALL ❑95. UNKNOWM ❑99 OTHER ❑ L.SINGLE WALL ❑95. UNKNOWN MA FACTURER 6-d 22.. BLE VIA LL ❑99. OTHER MANUFACTURER I.SARE STEEL ❑ 0. FRP COMPATIBLE WI IW%METHANOL COR MATERIALS AND ❑ 2 STAINLESS STEEL ❑ T, GALVANIZED STEEL I. BARESTEEL ❑ B.FRP ANIZEDIBLE L I=%METHANOL PROTECTION ❑]. PLASTICCOMPATIBLEVATM CONTENTS ❑ 2. STAINLESS STEEL ❑ T.GA FLEXIBLE OPE) ❑95. OTHER NN ❑ ]. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXIBLE(HpP� ❑99 OTHER ❑ a.FIBERGLASS ❑ S. FLEXIBLE(HOPE) ❑9g. OTHEP, ❑ 6. FIBERGLASS ❑5. STEEL4N COATING ❑ 9,CATHODIC PROTECTIONS. 1:19, CATHODIC PROTECTION ❑ STEEL W/COATING ❑95. UN"OVM -.. VII.PIPING LEAK DETECTION(Check ap thaN�py) -'. - . UNDERGROUND PIPING SINGLE WALL PIPING ABOVEGROUNO PIPING rPR' UflIZEO PIPING(G•ck ap loaf apPlyk p� SINGLE WALL PIPING L+ 1. ELECTRONIC UNE LEAK OUECTOR 3.0 GPM TEST WTM AUTO PUMP SHUTOF:FOR PPR URIZEO PIPING(Cneck,Maf appy): LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL L7 I. ELECTRONIC UNE LEAK DETECTOR].O GPM TEST W1TX ALTO PUMP SHUT OFF FOR LEAK, ALARMS SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ❑ 3.MONTHLY OZ GPM TEST ❑ } MONTHLY 02 GPM TEST ANNWLINTEGRITY TEST(01 GPM) •U�-D , ANNUAL INTEGRITY TEST(0.1 GPM) IJ a. UMLYVISUAL CHECK COPT NTIONAL SUCTION SYSTEMS CO NTIONAL SUCTION SYSTEMS(Geck ap NaM 5 DAILY VISUAL MONITORING OF PUMPINGPON' TEST ID I GPM) SYSTEM•}RIENlIWL PIPING INTEGRITY 5. DAILY VISUAL MONITORING OF PIPING AND PUMPINGSYSTEM . SAFE SUCTION SYSTEMS(NO VALVES IN BELOVIGROUNp PIPING) 13 BTRIENNIAL INTEGRITY TEST(0.1 GPM) : ❑ T. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING]: GRAVITY FLOWT. SELF MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(a 1 GPM) A GRAVITY FLOW(Cneck all Heal appM! ❑ 5. DAILY VISUAL MONITORING SECONDARILY CONTAINED PIPING 119 BIENNIAL INTEGRITY TEST(0.1 GPM) ' PRESSURIZED PIPING(CMC*an loaf appy)' SECONDARILY CONTAINED PIPING 10 CONTINUOUS TURBINE SUMP SENSOR WTH AUDIBLE AND VISUAL ALARMS AND PRESSURIZED PIPING(Cnack.11 that appy): (Cneo One) 10.CONTI US TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Deck one) el-I�( AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ AUTO PUMP SHUT OFF WHENALEAK OCCURS p AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM OrSCONN'c0T10N 0 AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE ANO SYSTEM DISCONNECTION / ❑e NOAUTOPUMPSMVTOFF /❑ F. NOAUTO PUMP SHUT OFF AUTOMATIC UNE LEAK DETECTOR 0.O GPX TEST)VATR FLOW SHUT OFF OR ®F RESTRICTION AUTOMATIC LEAK DETECTOR 12 ANNUAL INTEGRITY TEST 1111 GPM) 12.ANNUAL INTEGRITY TEST(OA GPM) SU @uGRAVITY SYSTEM' I] CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUALAIARMS 0 13 CONTINUOUAVITy YSTEM: ❑ 1]. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check ap Nat appy) ❑ 14. CONTINUOUS SUMP SENSOR WITROUT AUTO PUMP SHUT OFF-AUDIBLE ANO EMERGENCY GENERATORS ONLY(Lack as Mat appy) VISVALALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUTAUTO PUMP SHUT OFF•AUDIBLE AND VISUAL ❑ 15. AUTOMATIC LINE LEAK DETECTOR(].O GPH TEST)WITXOUT FLO`N SHUT OFF OR ALARMS RESTRICTION ❑ 15 AUTOMATIC UNE LEAK DETECTOR DI.O GPM TEST) C1 6.ANNUAL INTEGRITY TEST(O.I GPM) 2/A NNUAL INTEGRITY TEST ry.1 GPM) V 11. DAILY VISUAL CHECK DAILY VISUAL CHECK YBL DISPENSER CONTAINMENT -. DISPENSER CONTAINMENT 1 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE GATE TA EO CK ❑Z.CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUALALIRMS S.S. TRENCMUNER/ ON 0 CONTINUOUS DISPENSER PAN SENSOR W1TH AUTO SHUT OFF FOR DISPENSER•AUOIBLE AND VISUAL AURMS ❑ e,NONE MUNER/MONRORING IX.OWNERJOPERATOR SIGNATURE 1 nrYty Nat N•N !m n plwk•B Mnin ii W an4 emote b Ne E•it of mY hn9vA•E9s. SIGNATURE OF OPERATOR DATE NAME OF OWNER/OpERATOR(phlp L ,5 Dl TITLE FO WN OPERATOR I pbmtt Num:•r(fwbcYlve ply) • 'IApNm•0(fwbcal ws oMy) Permd Ezpintbn pay(Fvkol ma anlYl CUPAFORM(4199) FO"erly SYMC13 Fc"8