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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VL PIPING CONSTRUCTION a .0 n.t <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 1.PRESSURE D 2.SUCTION D 3.GRAVITY 452 D 1.PRESSURE D 2_ SUCTION D 3.GRAVITY 459 <br /> CONSTLI1CilON I. INGLE WALL D 3.LINED TRENCH D 99.OTHER 440 D 1.SINGLE WALL D 95.UNKNOWN 462 <br /> .tANUFACIBRF3t 2.DOUBLE WALL D 95.UNKNOWN D 2.DOUBLE WALL D 99.OTHER <br /> MANUFACTURER ) . i r7.f 461 MANUFACTURER 463 <br /> ❑I.BARE STEEL [16.FRP COMPATIBLE w/lo.% LhTHAmoL D 1.BARE STEEL D 6.FRP COMPATIBLE wtt m M wIoL <br /> D 2.STAINLESS STEEL [17.GALVAN®STEEL D Unmown [12. STAINLESS STEEL D 7.GALVANIZED STEEL <br /> ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑99. Other [13. PLASTIC COMPATIBLE W/CONTENTS D 8.FLEXIBLE(HDPE) D 99. OTHER <br /> FrBERGLASS D S.FLEXIBLE(HDPE) D 4. FIBERGLASS ❑9.CATHODIC PROTECTION <br /> 5.STEEL W/COATING D 9.CATHODIC PROTECTION 464 D 5. STEEL W/COATING ❑95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION o A 16n A orw®Y r.0 e.r6mil.e row.la 1. <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(L .dl trx p9y): PRESSUR17F.D PIPING(aa&.R that apply) <br /> D I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST 3YfD1 AUTO PUMP SHUT D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST MM AUTO PUMP <br /> OFF FOR LEAK SYSTEM FAILURE.AND SYSTEM DISCONNECTION* SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> D 2.MONTHLY 0.2 GPH TEST 02, MONTHLY 0.2 GPH TEST <br /> D 3.ANNUAL INTEGRUY TEST(0.1 GPH) D 3.ANNUAL INTEGRITY TEST(0.IGPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(a".8 Wt.,Iy) <br /> D S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING D S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): Cl 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> Cl 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLAW D7. SELF MONITORING <br /> D 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Ch III th.t apply): <br /> D 8. DAILY VISUAL MONITORING <br /> D 9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Chari d1 th. IWO PRESSURIZED PIPING(Chah.11 mn appy): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Chs*me) ALARMSAND(ab we) <br /> D v. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS D. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> *b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM Cl b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> ''' DISCONNECTION DISCONNECTION <br /> Uc. NO AUTO PUMP SHUT OFF Uc NO AUTO PUMP SHUT OFF <br /> I I. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT D 1I AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> D 12, ANNUAL INTEGRITY TEST(0.1 GPH) D 12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTIONK.RAVrTY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 013, CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS D 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(oai.0 6.t apply) EMERGENCY GENERATORS ONLY(Cha .0 d,Itwly) <br /> Cl 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF• D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> 015, AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW D 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> 016 ANNUAL INTEGRITY TEST(0.1 GPH) D 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> D 17. DAILY VISUAL CHECK D 17. DAILY VISUAL CHECK <br /> VNT.DISPENSER CONTAINIIIENT <br /> DISPENSER CONTAINMENT D I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE Cl 4.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 D 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS D S.TRENCH LINER/MONITORING <br /> CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR D 6,NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> DL OWNER/OPERATOR SIGNATURE <br /> 1 aaly t <br /> t.Pm a6aa h 72 mw I'd.cwnta to ma bu Dray laowla p <br /> SIGN T R FOWNE E DATE 470 <br /> NAM OWN P TO (p..Q 471 1 TITLE OF OWNER/OPERATOR 472 <br /> Pamn Number lFm foul ua wlY) 473 Pam.Appavad(Fot b 1..mtY) 474 Pam.&am.i.n Dne(Fa local u.e onlYl 475 <br /> UPCF(12/99 revised) 12 Formerly SWRCB Form B <br />