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FEE-23-2007 09 : 15 AM P. 14 JNIFIED PROGRAM CONSOLIDATED FORM/ y`1 YT'I( TANK: TA023no v`" ` PRM! P111=318 UNDERGROUND STORAGE TANKS - TANK PAGE 2 PAC N: FA900MV VI.PIPING CONSTRUCTION(chrh 01.1 71)) P.p7a7 H OUND V2OR0 P�INO SYSTEM TYPE M I.PRESSURE ❑2.SUCTION ❑3.GRAVITY 431 I,PRESSURE ❑2.SUCTION ❑3.GRAVITY .19 CONSTRUCTION ❑1,SINGLE WALL ❑3.LINED TRENCH ❑99 OTHER 40 ❑ I.SINGLE WALL ❑ P5.UNKNOWN ,µ2 MANUFACTURER®2 DOUBLE WALL Q95.UNKNOWN ❑2,DOUBLE WALL ❑q9 OTHER �r1 1--M1ANUFACTURER 03 El 1.BARB STEEL ❑6.PRpCOMPATIBLE W109>k METHANOL t_I1.BARE STEEL ❑6.PRPCOMPATIBLE N100%MRTHANOL ❑2.STAINLESS 87ML ❑ 7.OALVANIZBD STEEL [12.STAINLESS STEEL ❑7.OALVANIZEDSTepL ❑ PLASTICCOMPATE3LEW/CONTENTS ❑ 95.UNKNOWN ❑ PLASTIC COMPATIBLE W1 CONTENTS ❑95.UNKNOWN (�A.F78BROLASS ❑8,FLEXIBLE(HDPP) ❑ 99.OTHER ❑s.FIBERGLASS ❑5. W/COATING 139.CATHODIC PROTECTION .w ❑ 9_FLEXIBLE(HDPE) 11 W.OTHER STEEL ❑5.STEEL W/COATING ❑9,CATHODIC PROTECTION 4.1 VII.PIPING LEAK DETECTION(Cha"dilwre l to awm orse moeimnn qMommou to uhmintlmme keal y.) NDERO OUND PIPING SIN ABOVE BOUND PIPING EWA ING PREBSURIZEDPIPING(Checkalthele LE WA PIPING PMMA PRESSURIZED PIPING(Cheek.11 that apply), b7 ❑ I.ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST W=AUTO PUMP SHUT OFF ❑ L ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST 1=AUTO PUMP SHUT OFF FOR LEAK.SYSTEM FAILURE,AND SYSTEM DISCONNRCTION+AUDIBLE AND FOR LEAK,SYSTEM FAILURE,AN D SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑2.MONTHLY 82 OPH TEST ❑3,ANNUAL INTEGRITY TEST(0.1 GPH) ❑2.MONTHLY 0,2 GPM TEST ❑ 3.ANNUAL INTEGRITY TEST(0.I GPM) ❑C DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chwh @11 But apply) ❑S,DAILY VISUAL MONITORING OF PUMPING SYSTEM ITRIENN)EAL PIPING ❑5,DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM EV780RTTY TEST(0.1 GPM) ❑6.TRIENNIAL INTEGRITY TEST(D,I GPH) RAPE SUCTION SYSTEM$(NO VALUES IN BELDW GROUNDPIPINGP ❑ 1.SELF MONITORING SAFE SUC 11ON SYSTEMS(IVO VALUES IN BELOW GROUNDPIPMG), GRAVITY FLOW ❑7,SELF MONITORING ❑9.BIENNIAL INTEORITY TEST(0.1)GPH GRAVITY FLOW(Cheek all Net Appy), ❑ 1,DAILY VISUAL MONITORING C39.BIENNIAL INTEGRITY TEST(0.1)GPM SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Chat W But Apply): PRESSURIZED PIPING(Check all the epplyR 10.CONTINUOUS TURBINE SUMP SENSOR WM AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR 2=AUDIBLE AND VISUAL ALAR AND(CI,RketR) ALARMS AND(Cheat en e) AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a AUTO PUMP SNUT OPP WHEN A LEAK OCCURS A PUMP SHUT OPP FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b.AUTO PUMP SHUT OPP FOR LEAKS,SYSTEM FAILURB AND SYSTEM ONNECTION DISCONNECTION ❑A. NO AUTO PUMP SHUT OFF ❑ a. NO AUTO PUMP SHUT OFF 11 AUTOMATIC LINE LEAK DETECTOR(3,0 GPM TEST)W ITH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) 12.ANNUAL INTEORITY TEST(0.1 OPH) SUCI'ION/GRAWTV SYSTEM SUCTIONMRAVITY SYSTSM ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13,CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chink All Far appy) EMERGENCY GENERATORS ONLY(Clqu 48,,At p*) ❑ I4.CONTINUOUS SUMP SENSOR WITHOIIT AUTOPUMPSNUTO"' ❑ 14.CONTINUOUS SUMP SENSOR WWJoUT AUTO PUMP SHUT OFF• AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ II.AUTOMATIC LINE LEAK DETECTOR(3,0 GPM TEST)WITHOUT FLOW ❑ 15,AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION ❑ 16.ANNUAL fNTSGRITY TEST(0 I GPM) ❑ I6.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVEq DATE INSTALLED ❑ DAILY VISUAL CHECK 461 ❑ 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5,TRENCH LINER/MONITORING � CONTMUOUS DISPENSER PAN SENSOR}y O AUTO SHUTOFF FOR ❑ 6.NONE -DISPENSER AUDIBLE AND VISUAL ALARMS bq A IX.OWN ATOR TIGNATURE Imtl tlul YK atlpmtim keeN It NIN e,d rewfetl Oq blellp YnexlWe SIGNATUREWNBR/OPE TD DATE _ )6 To ,7 Aro NAME OF OWNER/OPBRATOR(,a,M) � TITLE OF OWNEWOPERATOR f „wRFNTc7ZTlnnxrT •C^�+ MANAGING MEMBER +n Pmvll NYnker(Fmbwl®rny) 473 PRpu ApP9vb(79rkwl uc Dory) 474 Pu A EnirAlkx but(Fx lxel W outer) 471 PT0003729 EE0000817 12/31/2006 12:00:OOAM UPCF(12/99 revised)