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MAY-11-2010 11 :23 AM p _ 05 UNIFIED PROGRAM CONSOLWATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 V1,1FIFINGCO1 t e PW oe LRJAERGROUND RUING ABOVEGROUND PIPING SYSTEM TYPE I.PRESSURE C 2.SUCTION [13,GRAVITY nye C I.PRESSURE C 2, SUCTION 0 3,GRAVITY 459 130497RUCDON 1 SINGLE WALL 0 3.LVED TRENCH C 99.OTHER uo C I. IN WALL C 95.UNKNOWN uv MANUPACGIRElt T DOUBLE WALL I3 93.UNKNOWN C 2.DOUBLE WALL ❑99.OTHER MANUFACG)RFR 461 MANUF'ACTURF.R u5 ❑1.BARE STEEL 0 6.FAP COMPATIBLE whnp54 MRTRANOL 0 1,BARE STEEL C 6.FRP COMPATIBLE W/JW%I TNANOL ❑2.4TAINLESS STEEL C 7.GALVANIZED STEM, ❑Unknp n ❑2. STAINLESS STERL C 7,GALVANIZED STEF.1. 0 A,PLASTIC COMPATIBLE W/CONTENTS C 99 Other C I. PLASTIC COMPATIBLE W/CONTENTS ❑S.FLEXIBLE_(HDPE) C 99 OTHER *.FIBERGLASS ❑I.FLEXIBLE(HOPE) 0 4. FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATNO ❑9.CATHODIC PROTECTION 464 ❑5. STEEL W/COATING ❑95.I INKNOWN 465 Vit PIPING LEAK DETECTION_ ,,hiel that. A dl,ficeitrth..11.e.LEM.ma0 ba h, Imd UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING u6 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check dl me appy): PRESSURIZED PIPING Knack ell the eppl7): []I_ELECTRONIC LINE LEAK DETECTOR 3,0 OPH TEST WITH AUTO PUMP SHUT ©L ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST WITH AUTO PUMP OPP FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION- I AUDIBLE AND VISUAL ALARMS. .AUDIBLE AND VISUAL ALARMS. []2.MONTHLY 0.2 OPH TEST 02, MONTHLY 0.2 OPH TEST ❑3.ANNUAL INTP.ORTTY TEST(0.10PH) O 3 ANNUAL INTEGRITY TEST MIGPH) C 4, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chink dl WB apply) El 5.DAILY VISUAL MONITORING OF PUMPING SYSTPM+TRIENNIAL PIPING ❑f DAILY VISUAL MONITORING OF PIPING AND KIMPINO SYSTEM NTEGAITY TEST(0.l OPH) SAFE SUCTION SYSTEMS(NO VN UES N BELOW OROINOMPINO) 0 6. TRIENNIAL INTEGRITY TEST(0,1 GRT) C3 7.SPT,F MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING); GRAVITY FLOW C7, 8ELFMONITORING C 9,BIENNIAL INTEGRITY TEST(0.1 OPH) GRAVITY FLOW(nwk dl the Vpy). ❑S. DAILY VISUAL MONITORTNO ❑9. BIENNIAL INTEGRITY TEST(0.1 OPH) SECONDARILY CONTAINED PIPING .SECONDARILY CONTAINED PIPING ]PRESSURIZED PIPING(Check ell the mply). PRESSURIZED PIPING ICheck all That"y). 10. CONTINUOUS TURBINE SUMPSENSORW11H AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR 'yITB AUDIBLE AND VL9UAL ALARMS AND(Chock teo) ALARMS AND(Crock eee) I6. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 09 AUTO PUMP SHUT OFF WHEN A LEAK OCCI;RS b. AUTO PUMP SHIT OFF FOR LHAK4,SYSTEM FAILURE AND SYSTEM C b AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Cc. NO AUTO PUMP SHAT OFF C)c NO AUTO PUMP SHUT OFF O 11. AUTOMATIC LINE. LEAK DETECTOR(3.0 GPH TEST)WITH FLOW BRUT C 11 AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION C 12, ANNUAL INTEGRITY TEST(0 1 OPH) 1312 ANNUAL INTF.GR(TY TEST(0.1 GPH) SUCTION/ORA VTTY SYSTEM SUCTIONKIRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS C 13, CONTINUOUS SUMP SENSOR-AUDIBLE AND VI9UAU ALARMS EMERGENCY GENERATORS ONLY(Cheek MI the mlb) EMERGENCY GENERATORS ONLY(Chaak dI rho Why) 014 CONITNUOVS SUMP SENSOR WITHOUT AUTO PIfMP SFIL7 OFF• 014 CONTINUOUS SUMP SENSOR%IjHOW.T AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3 0 GPH TFRT)WITHOUT PLOW Q IS. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION C 16.ANNUAL INTEGRITY TEST(0.1 OPH) 0 16.ANNUAL INTEGRITY TE4T(O I OPH) 0 17, DAILY VISUAL CHECK C 17. DAILY VISUAL CHECK VIU.DISPENSER CONTAINMENT DISPENSER CONTAINMENT C I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE C 4.DAILY VISUAL CHECK DATE INSTALLED u6 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5,TRENCH LINER/MONITORING O 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR C 6.NONE 469 1 O DISPENSERAUDIDLE AND VISUAL ALARMS -� IX.OWNER/OPERATOR SIGNATURE 1 Ike NfineWe�pmW4N herala la wa end tacurab m iha bmt.P my knoMed6e 30 O t RI A R DATE S > A. Iprlml 491TI1L OF WNERMPERATOR 473 E1 rJ trSYl �L>L/� !1P/✓ Pemut Numbar ala uu.my) Ori F.1trthAp D'9r.0 W4Duly) 4. rer4'Rw mw P."(P.r!-e.a.only) 415 UPCF(12/99 revised) 12 Formerly SWRCB Form 3