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I • <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br />Pg <br />VI. PIPING CONSTRUCTION (Chock all that apPly) -. <br />4'ERGROUND PIPING <br />❑ GRAVITY 458 <br />ABOVEGROUND PIPING <br />❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 459 <br />1 PRESSURE ❑ 2. SUCTION 3. <br />❑ WALL❑ 95. UNKNOWN 462 <br />❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑ 99. OTHER 4fi0 <br />1. SINGLE <br />yy OTHERE <br />W <br />2. DOUBLE WALL ❑ 95. UNKNOWN <br />2 DOUBLE WALLM <br />MANUFACTURER463 <br />UFACTUFIER461 <br />rt)� <br />❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE W1100% METHANOL <br />❑ 6. FRP COMPATIBLE WI 100%METHANOL <br />❑ 1. BARE STEEL <br />❑ 2. STAINLESS STEEL 7 GALVANIZED STEEL <br />ND <br />❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL <br />❑95. UNKNOWM <br />❑ ]. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLE%IBLE (HDPE)❑98. OTHER <br />❑ 3 PLASTIC COMPATIBLE WITH CONTENTS <br />OTHER <br />❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION <br />. FIBERGLASS ❑ 8. FLE%IBLEMDPE) W. <br />464 <br />❑ 5. STEELW/COATING ❑95. UNKNOWN 465 <br />❑ S. STEELW/COATING ❑ 9. CATHODIC PROTECTION <br />- LII. PIPING LEAK DE <br />I ECTION (Check an that apply)'. <br />ABOVEGROUND PIPING <br />UNDERGROUND PIPING <br />466 <br />SINGLE WALL PIPING Ki7 <br />SINGLE WALL PIPING <br />PRESSURIZED PIPING (Check all Thal appy): <br />PRESSURIZED PIPING(Check all that appy): <br />❑ 1. ELECTRONIC LINE LFJJ( DETECT00. 3.0 GPM TEST WITH AUTO PUMP SMUT OFF FOR LEAK <br />❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR <br />ELECTRONIC <br />SYSTEM FAILURE, AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS <br />LEAK SYSTEM FAILURE, AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL <br />ALARMS - <br />❑ 2. MONTHLY 02 GPM TEST <br />❑ 2. MONTHLY02GPH TEST <br />❑ 3. ANNUALINTEGRITY TEST (0. 1 GPM] <br />❑ 3. ANNUAL INTEGRITY TEST (0. 1 GPM) <br />❑ 4. DALY VISUAL CHECK <br />CONVENTIONAL SUCTION SYSTEMS (Check all that apply): <br />CONVENTIONAL SUCTION SYSTEMS: <br />❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br />❑ 5. DAILYMSUAL MONITORING OF PUMPING SYSTEM+ TRIENNIAL PIPING INTEGRITY <br />❑ 8. 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 />❑ 7. SELF MONITORING <br />GRAVITY FLOW. <br />GRAVITY FLOW (Check all Net appy): <br />❑ 9. BIENNIALINTEGRITYTEST(DIGPH) <br />❑ 8. DAILYVISUALMONITORING <br />❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPM) <br />SECONDARILY CONTAINED PIPING <br />SECONDARILY CONTAINED PIPING <br />PRESSURIZED PIPING (Check ell Nat appy): <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(rllxk <br />one) <br />a. AUTO PUMP BHUT OFF WHEN A LEAK OCCURS <br />Ib.one) <br />C1 a. AUTO PUMP SMUT OFF WHEN A LEAK OCCURS <br />AUTO OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM <br />❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION <br />❑ A NO AUTO PUMP SHUT OFF <br />❑ c. NO AUTO PUMP SHUT OFF <br />11. AUTOMATIC UNE LEAK DETECTOR (3.0 GPM TESTI WITH FLOW SHUT OFF ORRESTRIC <br />❑ 11 AUTOMATIC LEAK DETECTOR <br />❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) <br />SUCTIONASRAVITY SYSTEM: <br />SUCTIONIGRAVITY SYSTEM: <br />❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS <br />❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS <br />EMERGENCY GENERATORS ONLY (Check all that -PP(Y) <br />EMERGENCY GENERATORS ONLY (Check all that appy) <br />❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND <br />014 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+ AUDIBLE AND VISUAL <br />VISUALALARMS <br />❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) WITHOUT FLOW SHUT OFF OR <br />ALARMS <br />❑ 15. AUTOMATIC UNE LEAK DETECTOR (3.0 GPM TEST) <br />RESTRICTION <br />❑ 16. ANNUAL INTEGRITY TEST IDA GPM) <br />❑ 16. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 17. ONLY VISUAL CHECK <br />❑ 17. DAILY VISUAL CHECK <br />VIII. DISPENSER CONTAINMENT '.. <br />❑ 4. OAILYVISUALCHECK <br />DISPENSER CONTAWMENT FLOAT MECHAN M THAT SHUTS OFF SHEAR VALVE <br />❑ 5. TRENCH LINER <br />DATE INSTALLED 468 [32. CONTINUOUS DISPENSER PAN SENSOR+ AUDIBLE AND VISUAL ALARMS MONITORING <br />❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ❑ e. NONE 469 <br />IX OWNERIOPERATOR SIGNATURE: <br />I wMly Nat Ne mformadw plmocee herein is Wa aM af,rate to Me beet of my knowleaga. OO <br />SIGNATURE OF OWNERIOPER4T0?�/yyoo <br />y <br />472 <br />471 <br />NAME OF OWNERIOPERATOR(pnnt)_�r <br />TITLE OF OWNS ERA <br />/ N <br />ase <br />O V' (/ <br />4]4 Partnit Eepira8on Dats (Farlaal usa aMy) 4]5 <br />Pemlit Number (Fwlpml use pMy) 473 PMpM Approved (Forlool use OMy) <br />UPCF (1/99) Formerly SVYRCB Form B <br />