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FEB-23-2007 09 : 13 AM - P. 10 -mw UNIFIED PROGRAM CONSOLIDATED FORM j TANK: TABZJRBo1 PR p: 1110232311111UNDERGROUND STORAGE TANKS-TANK PAGE 2 FAC p: FA0003607 VI.PIPING CONSTRUCTION IcheAap th.apply) rap l>r7 UNDERGROUND PIPING ABO UND SYSTEM TYPE 1.PRESSURE ❑Z.SUCTION ❑ 3.GRAVITY esa ❑ I.PRESSURE ❑ 2.SUCTION ❑3.GRAVITY 4M CON9TRUCnm Eli SNOLE WALL 03.LINED TRENCH ❑99.OTHER 4a6 p 1.SNGLE WALL ❑95.UNKNOWN w ®2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99 OTHER MANUFACTURER "I MANUFACTURER 4163 ❑ I.BARE STEEL ❑6.PRP COMPATIBLE W Ir6H6 METHANOL ❑ LBARE STEEL ❑ 6.F1kP0OMPATIBLEw/T6p6kMBMANOL 0 2.STAINLESS STEEL O 7,GALVANIZED STEEL ❑2.STAINLESS STEEL ❑ 7,GALVANIZED STEEL ❑ PLASTIC COMPATIBLE W/CONTENTS 09.UNKNOWN ❑ PLASTIC COMPATIBLE W/CONTBNTS 096.UNKNOWN ®4.FIBERGLASS ❑ 9,PLEKIBLE(HDPE) ❑ 99.OTHRR ❑4.FIBSROLAES ❑ S.FLSRIBLE(HDPE) ❑".OTHER ❑S.STEEL W/OOATINO ❑ 9,CATHODIC PROTECTION 464 ❑ 5,STEEL W2oATING ❑9.CATHODIC PROTECTION KS VR,PIPING LEAK DETECTION clink al tlat U6oavl len 9ftM imriiuW .wllMaudmtMw6,o lo.al I UNDERGROUND PIPING ABOVEGR UND PIPING SINGLE W PIPING 466 9 LE WALL "7 PRRSSURIEED PIPING(Check oil that appb')i PRESSURIZED PIPING(Cheek oil that apply): ❑ L ELECTRONIC LINE LEAK DETECTOR 3,0 GPM TEST M=AUTO PUMP SHUT OFF ❑ 1,ELECTRONIC LINE LEAK DETECTOR 30 OPH TEST,6=AUTOFOR PUMPS NT OFF VISUAAIL IU,15 FAILURE AND SYSTEM DISCONNECTION+pODIBLe AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECnON+AUDIBLE AND VISUAL ALAWdS. VISUAL ALARMS. ❑ 2.MONTHLY 02 OPH TEST ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 2.MONTHLY 0.2 GPM TEST 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4,DAILY VISUAL CHECK CONVENTFONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Clink all that apply) ❑ 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM w TRIENNIBAL PIPING ❑ S.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEORTM TRBT(O.1 GPM) ❑6.TRIENNIAL INTEGRITY TEST(a I GPM) SAP&AUCTION SYSTEMS(NO VALUES IN BELOW GROIINWIFING): SAFE SUCTION SYSTEMS(NO VALUES IN BELOW OROUNDPIPING): ❑7.SELF MONITORING ❑ GRAVITY PLOW 7.SELF MONITORING ❑9.BIENNIAL NTBORITY TEST(0.1)GPM GRAVITY FLOW(Cheek all that appy)j ❑ S.DAILY VISUAL MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.1)OPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all khat apply), PRESSURIZED PIPING(Check it that apply): IO.CONTINUOUS TURBINE SUMP BEN BOR W ill AUDIBLE AND VISUAL IO.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE ANO VISUAL ( ALAMA D(Ma4oro) ALARMSAND(CMekano) •T �� UTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS pR b.AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM C3 b.AUTO PUMP SHUT OFF PGR LEAK&SYSTEM FAILURE AND SYSTEM - ISCONNECIION DISCONNECTION ❑o. NO AUTO PUMP SHUT DFP ❑c. NO AUTO PUMP SHUT OFF �xJ 11.AUMW7IC LINE LEAK DETECTOR(3 0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION AUTOMATIC LEAK DETECTOR ❑ ❑ 12,ANNUAL NTHGRITY TEST(O.I GPM) ❑ 12.ANNUAL INTEORITY TEST(O.I GPM) SUCTION/GRAVITY SYSTEM SUCTION/GRAVrrY SYSTEM ❑ 13.CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ I3,CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chek A wt apply) EMERGENCY GENERATORS ONLY(Clack Al th.Ealy) ❑ 14,CONTINUOUS SUM P SENSOR WITH r AUTO PUMP SHUT OFF' ❑ ]A.CONTINUOUS BUMP SENSOR W=Qla AUTO PUMP SHUT OFP• AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ IS.AUTOMATIC LINE LEAK DETECTOR(00 OPH TEST)WITHOU PLOW ❑ IS.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION ❑ 16,ANNUAL INTEGRITY TEST(o I GPM) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ n.OAILYVISUALCHRCK ❑ 17.DAILYVISUAL CHECK I Vitt.D PENSEE CONTAINMENT DISPENSER CONTAINMENT ❑ I,FLOAT MECHANISM THAT SHUTS OPP SHEAR VALVE 1 DATE INSTALLED ❑4.DAILY VISUAL CHECK 461 ❑2 CONTINUOUS DISPENSER PAN SENSOR*AUDIBLE AND VISUAL ALARMS S.TRENCH LINER/MONITORING X03 �CONTINUOUS DISPENSER PAN SENSOR WM AUTO SHUT OFF FOR []6,NONE b /•7 [SPENSER+AUDIBLE AND VISUAL ALARMS �a ti IX OWNERIMPERATORSIGNAT IowU N.14 Nfamutioa povidad n:elehwMaadamv.twlM but ofty SIGNATU FOWNE P TOR OpTE 410 6-0 7 NAME OF OWNEIVOPERATOa(prmt) TITLE OF OWNBR/OPERATOR all MANAGING MEMBER 972 Peach N,n,Wr(Fw b.alur ody) 479 Pmwk APP�N(Fwia.ivaoonly) 474 P. "FN,M .Nc,(F.lmaluo my; 475 PT0003729 EE0000817 12/31/2006 12:00:OOA-1 UPCF(12/99 revised)