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UNIFIED PROGRAM CONSOLIDATED FORM <br />i TANKS <br />UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br />Page <br />V1. PIPING CONSTRUCTON (Chack al/thatappy) - - <br />ULPERGROUND PIPING <br />ABOVEGROUND PIPING <br />SYSTEMTYPE <br />W,. PRESSURE ❑ 2. SUCTION - ❑ 3. GRAVITY 458 <br />❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 459 <br />CONSTRUCTIOW <br />❑ 1- SINGLE WALL ❑ 3. UNEDTRENCH ❑ 99. OTHER 460 <br />❑ 1. SINGLE WALL - ❑ 95. UNKNOWN - OU <br />MANUFACTURE <br />2. DOUBLE WALL ❑ 95. UNKNOWN . <br />[12. DOUBLE WALL [199. OTHER <br />ANUFACTURER 461 <br />MANUFACTURER 483 <br />❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE Wl 100% METHANOL <br />❑ 1. BARE STEEL ❑ 6. FRPCOMPATIBLE W/10099METRANOL <br />MATERIALSAND <br />❑ 2. STAINLESSSTEEL ❑ 7. GALVANIZEDSTEEL <br />❑ 2. STAINLESS STEEL Cl 7. GALVANIZED STEEL <br />CORROSION <br />❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN <br />❑ 3. PLASTIC COMPATIBLE `NTH CONTENTS 118. FLEXIBLE (HDPE) 099. OTHER <br />PROTECTION <br />4. FIBERGLASS ❑ S. FLEXIBLE (HOPE) 099. OTHER <br />❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION <br />❑ S. STEEL W/ COATING ❑ 9. CATHODIC PROTECTION 464 <br />❑ 5. STEELWICOATING ❑95. UNKNOWN 465 <br />8B. PIPING LEAK DETECTION (Checkal/Nat appy),:' <br />UNDERGROUND PIPING <br />ABOVEGROUND PIPING <br />SINGLE WALL PIPING 466 <br />SINGLE WALL PIPING _ 40 <br />PRESSURIZED PIPING (Check all that apply): <br />PRESSURIZED PIPING (Check all that appy): <br />❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR <br />❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK <br />LEAK SYSTEM FAILURE. AND SYSTEM DISCONNECTION - AUDIBLE AND VISUAL <br />SYSTEM FAILURE. AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS <br />ALARMS <br />❑ 2. MONTHLY 0.2 GPM TEST <br />❑ 2. MONTHLY 0.2 GPH TEST <br />❑ 3. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 3. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 4. DAILY VISUAL CHECK <br />CONVENTIONAL SUCTION SYSTEMS (Check all that appy): <br />CONVENTIONAL SUCTION SYSTEMS: <br />❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br />❑ 5, DAILY VISUAL MONITORING OF PUMPING SYSTEM+ TRIENNIAL PIPING INTEGRITY <br />TEST (0.1 GPM) <br />❑ 6. TRIENNIAL INTEGRITY TEST (0.1 GPM) <br />SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): <br />SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): <br />❑ 7. SELF MONITORING <br />❑ T SELF MONITORING <br />GRAVITY FLOW. <br />GRAVITY FLOW (Check all that apply): <br />❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPM) <br />❑ 8. GAILYVISUAL MONITORING <br />❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPM) <br />SECONDARILY CONTAINED PIPING <br />SECONDARILY CONTAINED PIPING <br />PRESSURIZED PIPING (Check all that apply): <br />PRESSURIZED PIPING (Check all that appy): <br />10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br />10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Chess <br />:....�((CM✓✓/ck one) <br />AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />one) <br />❑.. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />LJ b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM <br />DISCONNECTION <br />❑ It. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNEC11ON <br />❑ c NOAUTO PUMP SHUT OFF <br />❑ c NOAUTO PUMP SHUT OFF <br />11. AUTOMATIC UNE LEAK DETECTOR (3.0 GPM TESTI WITH FLOW SHUT OFF OR <br />❑ <br />RESTRICTION <br />11. AUTOMATIC LEAK DETECTOR <br />❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) <br />SUCTIONIGRAVITY SYSTEM: <br />SUCTICNIGRAVITY SYSTEM: <br />❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS <br />.-..,,_....,..-.. _...._. <br />❑ 13. CONTINUOUS SUMP SENSOR• AUDIBLE AND VISUAL ALARMS <br />_ <br />EMERGENCY GENERATORS ONLY (Check all that appy) <br />EMERGENCY GENERATORS ONLY (Check all that apply)14. <br />❑ CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND <br />❑ 14. CONTINUOUS SUMP SENSOR`MTHOUT AUTO PUMP SHUT OFF+ AUDIBLE AND VISUAL <br />VISUALALARMS <br />ALARMS <br />❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) WITHOUT FLOW SHUT OFF OR <br />❑ 15. AUTOMATIC UNE LEAK DETECTOR (3.0 GPM TEST) <br />RESTRICTION <br />❑ 16. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 16. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 17. DAILYVISUALCHECK <br />❑ 17. DAILY VISUAL CHECK <br />VIII. DISPENSER CONTAINMENT:":'. <br />DISPENSER CONTAINMENT1. FLOAT MECHAN M THAT SHUTS OFF SHEAR VALVE 134. DAILY VISUALCHECK <br />DATE INSTALLED 468 2. CONTR4L/0US DISPENSER PAN SENSOR - AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH UNER / <br />MONITORING <br />❑ 3. CONTINUOUS DISPENSER PAN SENSOR VATH AUTO SHUT OFF FOR DISPENSER• AUDIBLE AND VISUAL ALARMS ❑ 8. NONE 48B <br />IX OVINERIOPERATOR SIGNATURE'. <br />I candy Mat Ne intbllaebon pmWEeE heroin is We and acante to Ne best of my knowledge. <br />SIGNANRE OF OWNER/OPERATOR�/ DATE 470 <br />it Do <br />NAME OF OWNER/OPERATOR(pint) 471 <br />Uase <br />TITLE OF OWNE PERATOR - 472 <br />1+64 <br />M L�, <br />m s <br />UPCF (1/99) 0 <br />0 <br />Formerly SWRCB Form B <br />