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. 13WOUtD PROGRAM CONSOLIDATED UNDERGROUND STORAGE TANKS - TANK PAGE 2 SYSTEM TYPE O L PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONMUCTION ❑ L SINGLE WALL ❑ 3. LINED TRENCH ❑ 99. OTHER MANUFACTURER ® 2. DOUBLE WALL ❑ 95. UNKNOWN MANUFACTURER ENVIRON ❑ 1. BARE STEEL ❑ 6. PRP COMPATIBLE w/100% METHANOL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ Unknown ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS ❑ 99. Other ❑ 4. FIBERGLASS ® S. FLEXIBLE (HOPE) ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464 ff."Ll I ABOVEGROUND PIPING 458 [11. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 459 460 ❑ 1. SINGLE WALL ❑ 95. UNKNOWN 462 ❑ 2. DOUBLE WALL ❑ 99. OTHER 461 MANUFACTURER ❑ 1. BARE STEEL ❑ 2. STAINLESS STEEL ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS [14. FIBERGLASS ❑ 5. STEEL W/COATING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check a0 that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0.IGPH) CONVENTIONAL SUCTION SYSTEMS ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): [17. SELF MONITORING GRAVITY FLOW ❑ 9. BffiNNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all Net apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check om) []& AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 OPH TEST) WITH FLOW SHUT OFF OR RESTRICTION ❑12. ANNUAL INTEGRITY TEST (0. 1 GPH) SUCTION/GRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW 463 [16. FRP COMPATIBLE W/1 00% METHANOL ❑ 7. GALVANIZED STEEL ❑ 8. FLEXIBLE (HDPE) ❑ 99. OTHER ❑ 9. CATHODIC PROTECTION ❑ 95. UNKNOWN 465 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check ell that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEMDISCONNECTION+ AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check 0that apply) ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING GRAVITY FLOW (Check all Net apply): ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [113. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITH AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS SHUT OFF OR RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TESL) ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ I6. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 17. DAILY VISUAL CHECK [117. DAILY VISUAL CHECK VDI. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ® 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED MS ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+ AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINEA/MONITORING 1997 ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6. NONE 469 DISPENSER + AUDIBLE AND VISUAL ALARMS I IX. OWNER/OPERATOR SIGNATURE I I ceatify Naz Ne mfotmetionprovided hemm is true and acemate to the ofnry awledge. SIGNATURE OF OWNER(OPERATOR DATE (i/I (,21q © I 470 OPERATIONS MANAGER UPCF (1/99 revised) Fonn B