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UNIFIED PROGRAM CONSOLIDATED FORM o� <br /> �\� TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VL PIPING CONSTRUCTION a.t A" M_af <br /> UNDERGROUND PIPING I ABOVEGROUND PIPING <br /> SYSTEM TYPE 1.PRESSURE 0 2.SUCTION ❑3.GRAVITY 439 1 0 1.PRESSURE O 2. SUCTION -❑3.GRAVITY 459 <br /> ET 1.%SNGLE WAIL 0 3.LINED TRENCH 099.OTHER -440 ❑1.SINGLE WALL 0 95.UNKNOWN 44] <br /> MAMIFACMIFII Z.DOUBLE WAIL O 93.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER <br /> MAN ACfURER kl MANUFACTURER 465 <br /> 0 1.BARE STEEL O 6.FRP COMPATIBLE YANK MEnuN01. 0 1.BARE STEEL. 0 6.FRP COMPATIBLE W/I99x MEDrANOL <br /> (:12.STAINLESS STEEL. 0 7.GALVANIZED STEEL. ❑Udappwn 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 0 3'PLASTIC COMPATIBLE W/CONTENTS 0 99. 01hw [33. PLASTIC COMPATIBLE W/CONTENTS 0 a.FLEXIBLE(HDPE) 0 99. OTHER <br /> 4.FIBERGLASS ❑a.FLEXIBLE(HDPE) O 4. FIBERGLASS O 9.CATHODIC PROTECTION <br /> .STEEL w/coAnNG 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING 0 95.UNKNOWN 46f <br /> VII.PIPING LEAK DETECTION o.&all ml A .rw mw: m.0 lm mbmbd mJ.bol. <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WAIL PIPING 466 SINGLE WALL PIPING M7 <br /> PRESSURIZED PIPING(Omr*.O tk.Iappyk PRESSURIZED PIPING(CMA.O bn.plyy <br /> ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST\\M AUTO PUMP SH TT 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WM 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 /> ❑2.MONTHLY 0.2 GPH TEST [32. MONTHLY 0.2 GPH TEST <br /> 0 3.ANNUAL INTEGRITY TEST(O.IGPH) 0 3.ANNUAL INTEGRITY TEST(O.IGPH) <br /> 0 4. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(w .a nu.pply) <br /> 0 S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 5. DAILY VISUAL MONITORING OF PIPING AND PIMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUFIDPIPING): O 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 0 7. SELF MONITORING <br /> 0 9.BIENNIAL INTEGRR'Y TEST(0.1 GPH) GRAVITY FLOW(Ch k.116 apply): <br /> OZ. DAILY VISUAL MONITORING <br /> 0 9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(C .11 W,wl,): PRESSURIZED PIPING(C .11 W appyk <br /> 10. CONTINUOUS TURBINE SUMP SENSOR MM AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR Wn AUDIBLE AND VISUAL <br /> ALARMS AND(O.*am) ALARMS AND(a1 w) <br /> 01 AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE.AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> c. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) 'II fTFI FLOW SHUT 0 11 AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. ANNUAL INTEGRITY TEST(0.1 GPIT, <br /> SUCTION/GRAVITY SYSTEM SUCrION/GRAVTTY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(oma.0 i appy) EMERGENCY GENERATORS ONLY(Ch.rt.p"apply) <br /> 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW [115. AUTOMATIC LINE LEAK DETECTOR O.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 017. DAILY VISUAL CHECK 017. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 01.FLADAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04.DAILY VISUAL CHECK <br /> DATE INSTALLED 4ea 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 5,TRENCH LINER/MONITORING <br /> .CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> DL OWNER/OPERATOR SIGNATURE <br /> I. ly Jn dlwei.uu.eWww.w.m b.fmy Yw ,a. <br /> SIGNATU 01 R/OPERATOR DATE 479 <br /> NAMEOF R(pnnl 471 TITLE OF OWNNE OPERATOR 471 <br /> Ur4� <br /> Pm.n.N WI w y/ 4n F., App .,b a1 u.e only) 474 475 <br /> UPCF(12/99 revised) 12 *0/ Formerly SWRCB Form B <br />