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- UNIFIED PROGRAM CONSOLIDAieo F�hm TANKS <br />UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br />r Page M <br />Vi. PIPING CONSTRUCTION (Check aN that appy) <br />[JQERGRWNO PIPING <br />� ❑ GRAVITY 458 <br />ABOVEGROUND PIPING <br />❑ 1. PRESSURE Cl 2. SUCTION ❑ 3.GRAVITY 459 <br />SYSTEM TYPE <br />SSURE ❑ 2. SUCTON 3. <br />❑95. UNKNOWN - 462 <br />WALL ❑ ]. LINED TRENCH ❑ W. OTHER 460 <br />_ <br />❑ 1. SINGLE WALL Q 99 OTHER <br />CONSTRUCTION/GLE <br />MANUFACTUREUBLE <br />WALL ❑ 95. UNKNOWN <br />❑ 2. DOUBLE WALL <br />a67 <br />461 <br />CTURER <br />MANUFACTURER <br />E STEEL ❑ 6. FRP COMPATIBLE W/100%METHANOL <br />r <br />❑ 1. BARE STEEL ❑ S. FRP COMPATIBLE W/100%METHANOL <br />MATERIALS ANDNLESS <br />STEEL ❑ 7. GALVANIZED STEEL <br />❑ Z. STAINLESS STEEL Q 7 GALVANIZED STEEL <br />❑ 8. FLEXIBLE (HOPE) ❑99. OTHER <br />CORROSION <br />PROTECTION <br />STIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN <br />❑ 3. FUSTIC COMPATIBLE WITH CONTENTS <br />❑ 9, CATHO010 PROTECTION <br />ERGLAS$ ❑ 8. FLEXIBLEMOPE) ❑99. OTHER <br />❑ d. FIBERGLASS QgS. UNKNOWN 485 <br />EEL W/COATING ❑ 9. CATHODIC PROTECTION 464 <br />❑ 5. STEEL W/COATING <br />I% PIPING LEAK DETECTION <br />(Check ah that appy) <br />A80VEGROUND PIPING <br />UNDERGROUND PIPING <br />a68 <br />SINGLE WALL PIPING <br />SINGE WALL PIPING <br />PRESSURIZED PIPING (Check all that appyJ: <br />PRESSURIZED PIPING (Chxk all that appy): <br />❑ 1. ELECTRONIC UNIE LEAK DETECTOR 3.0 SPH TEST WTH AUTO PUMP SHUT OFFR LEAK <br />❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR <br />SYSTEM FNLURE, ANO SYSTEM DISCONNECTION AUDIS E AND VISUAL ALARMS <br />LEAK SYSTEM FAILURE, AND SYSTEM DISCONNECTION • AUDIBLE AND VISUAL <br />ALARMS <br />❑ 2. MONTHLY 0.2 GPM TEST <br />Q 2. MWTHLYG2GPH TEST <br />❑ 1 ANNUAL INTEGRITY TEST (0,1 SPH) <br />❑ 3. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 4. DAILYVISUALCHECK <br />CONVENTIONAL SUCTION SYSTEMS 'Cl all Ihat appy): <br />CONVENTIONAL SUCTION SYSTEMS: <br />❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br />❑ S. OAILYVISUALMONITORING OF PUMPING SYSTEM• TRIENNIAL PIPING INTEGRITY <br />Q 6. TRIENNIAL INTEGRITY TEST (0.1 GPM) <br />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 />Q 7, SELF MONITORING <br />GRAVITY FLOW. <br />GRAVITY FLOW (Check au that appy): <br />❑ 9. BIENNIAL INTEGRITY TEST (0. 1 GPM) <br />❑ 8. GAILYVISUALMONITORING <br />❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPM) <br />SECONDARILY CONTAINED PIPING <br />SECONDARILY CONTAINED PIPING <br />PRESSURIZED PIPING(Chxk a9 that appy): <br />PRESSURIZED PIPING (CI all that appy): <br />SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br />10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (dlarx <br />10. CONTINUOUS TURBINE <br />aro) <br />ane) <br />y(Char <br />j9'. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />Q E. AUTO PUMP SHUT FOR LEAKS, SYSTEM FAILURE AND SYSTEM <br />❑ 0. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION <br />C1 <br />DISCONNECTION <br />❑ c NO AUTO PUMP SHUT OFF <br />❑ c NO AUTO PUMP SHUT OFF <br />x"', . NE LEAK DETECTOR (3.0 GPM TEST) WITH FLOW SHUT OFF OR <br />Q 11 AUTOMATIC LEAK DETECTOR <br />RETORATIC TION <br />❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) <br />SUCTION/GRAVITY SYSTEM: <br />SUOTIONIGRAVITY SYSTEM: <br />❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS <br />❑ 13CONTINUOUS SUMP SENSOR• AUDIBLE AND VISUAL ALARMS <br />EMERGENCY GENERATORS ONLY (Check all that appy) <br />EMERGENCY GENERATORS ONLY (Chxk all Nat appy) <br />❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF - AUDIBLE AND <br />❑ 14. CONTINUOUS SUMP SEN500. WITHOUT AUTO PUMP SHUT OFFAUDIBLE AND VISUAL <br />VISUAL ALARMS <br />ALARMS <br />❑ 15. AUTOMATIC UNE LEAK DETECTOR (3.0 GPM TEST) WTHOUT FLOW SHUT OFF OR <br />Q 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. DAILYVISUAL CHECK <br />❑ 17, DAILY VISUAL CHECK <br />VOL DISPENSER CONTAINMENT==- - <br />- '- ❑ 4. DAILYMSUALCHECK <br />DISPENSER CONTAINMENT 1. FLOAT MECHAN MTHAT SHUT, IFF SHEAR VALVE ❑ S. TRENCH LINER/ <br />DATE INSTALLED 488 2. CONPWIOUS DISPENSER PAN SENSOR-AUDIBE AND VISUAL ALARMS MONITORING <br />❑ ]. CONTINUOUS DISPENSER PMI SENSOR WITH AUTO SHUT OFF FOR DISPENSER •AUDIBE AND VISUAL ALARMS ❑ 8. NONE 49 <br />IX OWNERIOPERATOR SIGNATURE. <br />I car* Nat me IMamatipn pmaIle0 herein ie Ms and arcuate m me Dear pl my MnaMeOge. 470 <br />SIGNATURE OF OWNER/OP�/ GATEr l ` DO <br />472 <br />471 TITLE OF OWNE ERATOR <br />NAME OF OWNER/OPERATOR(piM) <br />Uase m s11JI6f2 <br />1 <br />04 Permit E/y'valbn Date (Forlaal use ppy) d75 <br />Permit NumBer (Fprlpal use pNy) 473 Pemlh At) a d(Fp'IlKaI sappy) <br />UPCF (1/99) 0 0 Formerly SWRCB Farm B,Y <br />