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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 'VI.PIPING CONSTRUCTION(Chack ao Naf appy) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE SUCTION ❑ 3.GRAVITY ❑ 1. PRESSURE ❑ 2.SUCTION ❑ 3. GRAVITY CONSTRUCTION/ i:w SINGLE WALL 3. UNEDTRENCH ❑99. OTHER ❑ 1. SINGLE WALL 1195. UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL 1:195. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ S. FRP COMPATIBLE Wl 1W%METHANOL ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE W/iW%METHANOL MATERIALS AND ❑ 2.STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE PATH CONTENTS 095. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 118. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEKIBLE(HOPE) V`SS9THER ❑ 4. FIBERGLASS ❑ 9.CATHODIC PROTECTION ❑ 5. STEELW/COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEELWICOATING El 95 UNKNOWN - "VII.PIPING LEAK DETECTION(Check0Motappy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING - PRESSURIZEDPIPING(Chock a9 flat appy): ��h � PRESSURIZED PIPING(Check as that appy): - ❑ 1. ELECTRONIC LINE LEAK DEFECTOR 3.0 PH TESt WLTH 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.AUDIBLE AND VISU)LL SYSTEM FAILURE,AND SYSTEM DISCONNECTION AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2.MONTHLY0.2GPH TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 CPN) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. TRIENNIAL INTEGRITY TEST IDA GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELFMONITORING ❑ T. SELFMONITORING GRAVITY FLOW: GRAVITY FLOW(Check all Nat apply): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0 1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Chock all that appy): PRESSURIZED PIPING(Chack.9 Nal apply): 10. CONTINUOUS TURBINE SUMP SENSOR HATH AUDIBLE AND VISUAL ALARMS AND 10,CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(c31ea one) (Chea anal ❑ a. AUTO PUMP SHUT OFF MENA LEAK OCCURS ❑ a.AUTO PUMP SHUT OFF MENA LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 11p. ALTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c. NOAUTO PUMP SHUT OFF ❑ c NOAUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11.AUTOMATICLEAKDETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY TEST 10.1 GPM) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION/GRAVITY SYSTEM: SUCTIOWGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUALALARMS ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check aft Mat HAW EMERGENCY GENERATORS ONLY(Chock 0 Nat apptA ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR(10 GPM TEST) RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPM ❑ 18.ANNUAL)NTEGRITY TEST IDI GPM) ❑ 17. DAILYVISUALCHECK ❑ IT DAILY VISUAL CHECK VUL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 5. T ENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WMTH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND WSUALALARMS 8. NONE IX OWNERIOPERATOR SIGNATURE 1 naify Nat Na Informa5an proaIla0 0anom is 4ua and accurate to Na East of my knoxlaE9e. SIGNATURE OF OVMER/OPERATOR DATE NAME ER/OPERATOR( t TITLEOFOWNEILOPERATOR Pnmit Numbar(Forbcal use onM Permit Approved(Forkaal use any) PemM E>puatlon Gale fForbca/use aNy) :UPAFORM(4199) Formerly SWRCB Farm 8