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• NIFIED PROGRAM CONSOLIDATED F TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION(Check as met apply) UNDERGROUND PIPING ABOVEGROUND PIPING P ❑ 1, PRESSURE ❑ 2. SUCTION ❑ 1 GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY N/ ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑98. OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN ER ❑ 2. DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ S. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ 5. FRP COMPATIBLE W/100%METHANOL D ❑ p, STAINLESS STEEL ❑ ]. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ ]. GALVANIZED BTEEL ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WATM CONTENTS ❑ B. FLEXIBLE(HDPE) 1199. OTHER ❑ 6. FIBERGLASS ❑ B. FLEXIBLE(HDPE) ON.OTHER ❑ a. FIBERGLASS ❑ 9. CATMODICPROTECTION ❑ S. STEELW/COATING ❑ 9. CATHODICPROTECTION ❑ S. STEEL WI COATING 095. UNKNOWN VII:.PIPING LEAK DETECTION(Check aN thsrappyl UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL%PING PRESSURIZED PIPING(Chsck as that apply): PRESSURIZED PIPING(Deck ae that appy): ❑ L ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WATH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION r AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION;AUDIBLE AND VISUAL ALARMS ALARMS ❑ 1 MONTHLY 0.2 GPM TEST ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3. ANNYVJSlJUAL LCHR KEST(Od GPM) ❑ 6. GAILY VISWLCXECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check ap that apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM r TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ S. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ ]. SELFMONRORING ❑ T. SELFMONITORING GRAVITY FLOW GRAVITY FLOW(Check 0 tlet apphn: ❑ S. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ t DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check as Mat appy): PRESSURIZED PIPING(Cheb,Ad that apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMSAND (C CONTINUOUS po,one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(chaNc one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ p NO AUTO PUMP SHUT OFF ❑ c NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR D.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12.ANNUAL INTEGRITY TEST(0.1GPH) SUCTIONIGRAVITY SYSTEM: SUCTIONIGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR r AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR r AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chamber atl that appy) EMERGENCY GENERATORS ONLY(Check ae Mat appy) ❑ 10. CONTINUOUS SUMP SENSOR WSTHOUT AUTO PUMP SHUT OFF r AUDIBLE AND 1314. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF r AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR 13.0 GPM TESTI RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK NII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR r AUDIBLE AND VISUALALARMS ❑ S. TRENCH UNER I MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER r AUDIBLE AND VISUAL ALARMS ❑ S. NONE 0L OWNERIOPERATOR SIGNATURE I ar9ly Mat Me Information provided herein is We and accurate to the best of my krwMed9a. SIGNATURE OF OWe1ER10PERATOR GATE NAME OF OWNER/OPERATOR(pdn0 TITLE OF OWNERNPERATOR Parmd Npmbar(Forlocal uaa oNN Pelmd Approved(Forlocal use only) Pe1mM1 Expvadan Dats(Forbcal use only) 1 -0 +3199 CUPAFORM(4/99) Formerly SWRCS Farm B