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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANKS UNDERGROUND PIPING VL PIPING CONSTRUCTION(CMck aY thesappy) SYSTEM TYPE ❑ 1 PRESSURE ABOVEGROUND PIPING ❑ 2. SUCTION 3 GRAVITY ❑ CONSTRUCTION/ 111. SINGLE WALL 113. LINED TRENCH 1. PRESSURE ❑ 2. SUCTION MANUFACTURER 132, DOUBLE WILL ❑99. OTHER ❑ 1. SINGLE WALL ❑ 9. GRAVITY ❑95. UNKNOWN 1195.El 2 DOUBLE WALL UNKNOWN MANUFACTURER MANUFACTURER ❑99. OTHER ❑ 1.BARESTEEL ❑ e. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2, STAINLESS STEEL ❑ 1. BARESTEEL CORROSION ❑ T GALVANIZED STEEL ❑B. FRP COMPATIBLE W/100%METHANOL PROTECTION ❑ 3. PLASTIC COMPATIBLE WITHCONTENTS132 STAINLESS STEEL �95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ ] GALVINIZEDSTEEL . FLEXIBL ❑ 9. FIBERGLASS ❑ 8E(HDPE) 099, OTHER 11 4, FIBERGLASS 118. FLEXIBLE(HDPE) 1199. OTHER ❑ 5. STEEL W/COATING ❑ 9. CATHODICPROTECTION ❑ 9. CATHODIC PROTECTION ' ❑ 5. STEEL W1 COATING VIL PIPING LEAK DETECR 5, STEEL a1 COATING - ❑95. UNKNOWN SINGLE WALL PIPING UNDERGROUND PIPING PRESSURIZED PIPING(CMck al/fhafappy): ABOVEGROUND PIPING ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3D GPH TEST WITH AUTO PUMP SHUT OFF FOR PRESSURIZED PIPING(Cheri aN thele SINGLE WALL PIPING LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION AUDIBLE ANO VISUAL ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESTWITH AUTO PUMP SHUT OFF FOR LEAK, ALARMS 2MONTHLY 0.2 GPM TEST SYSTEM FAILURE.AND SYSTEM DISCONNECTION a AUDIBLE AND VISUALALARMS ❑ . ❑ 2. MONTHLY 02 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: ❑ 4. DAILY VISUAL CHECK DAILY UAL ❑ S(Cheek all hat 5.TEST(0I1 GPH) OF PUMPING SYSTEM eTRIENNIAL PIPING INTEGRITY ❑ CONVENTIONAL VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST VI GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOWGROUND PIPING): ❑ e TRIENNIAL INTEGRITY TEST IDA GPH) Cl T SELFMONITORING SAFE SUCTION SYSTEM'(NO VALVES IN BELOWGROVND PIPING): GRAVITY FLOW ❑ 7. SELF MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0,1 GPH) GRAVITY FLOW(Check ad Maf appy): luR0rrRTe-sTGB. DAILY VISUAL MONITORING SECONDARILY CONTAINED PIPING ❑ 9. BIENNIALINTEGRITYTEST(OAGPH) PRESSURIZED PIPING(Cheek all that appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND PRESSURIZED PIPING(Check ad that SECO appy).NOARILY CONTAINED PIPING (Check one) ❑ e.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 10.CONTINUOUS TURBINE SUMP SENSOR'MTH AUDIBLE AND VISUAL ALARMS AND(Aleck ane) ❑ b.AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF 13b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ 11. AUTOMATIC LINE LEAK DETECTOR 13.0 GPH TEST)NTH FLOW SHUT OFF OR IJ c. NO AUTO PUMP SHUT OFF RESTRICTION 12.ANNUAL INTEGRITY ❑ 11. AUTOMATIC LEAK DETECTOR INTEGRITYTEST(0.1 GPH) SUCTION/GRAVITY SYSTEM: 1112 ANNUAL INTEGRITY TEST Al GPH) ❑ 13. CONTINUOUS SUMP SENSOR I AUDIBLE AND VISUAL ALARMS SUCTIOWGRAVITYSYSTEM: EMERGENCY GENERATORS ONLY(Check as Maf eppty) ❑ 13 CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL AIARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTOPUMP SHUT OFF•AUDIBLE AND EMERGENCY GENERATORS ONLY(Check aY Maf appy) VISUAL ALARMS ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 4 AUDIBLE AND VISUAL ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3-0 GPH TEST)WITHOUT FLOW SHUT OFF OR ALARMS RESTRICTION ❑ 18.AUTOMATIC LINE LEAK DEFECTOR SD GPH TEST) ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17. DAILYVISUALCHECK ❑ 18. ANNUAL INTEGRITY TEST IDA GPH) ❑ 1]. DAILY VISUAL CHECK VBL DISPENSERCONTAINMENT DISPENSER COertA1NMEjjj ECHANISM THAT SHUTS OFF SMEAR VALVE DATE INSTALLED UOUS DISPENSER PAN SENSOR♦AUDIBLE AND VISUAL ALARMS ❑ 4, DAILY VISUAL CHECK OUS DISPENSER PAN SENSOR HATH AUTO SHUT OFF FOR DISPENSER t AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING NONE I aeNry mal me Inlolma5one an,att rote tome beet f myMwvaaa9eXOWNER/OPERATOR SIGNATURE SIGNATURE OF OWNER/ DATE NAME OF OWNEWOPERATOR(Pont) TITLE OF OWMEWOPERATOq Permit Number(Far local uas any) PartnitA pprovea(FDrlogl uas onyJ Permit Ekpbaecn Dale(Fprbnl use pny) :3d- L a CUPAFORM(4/99) • • Forrnedy SWRCB Form B