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- FIED PROGRAM CONSOLIDATED FOoFA <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VL PIPING CONSTRUCTION(ChackaO Naf ayply) _ <br /> UNDERGROVNO PIPING <br /> ABOVEGROUND MPING - <br /> $YSTEMttPE 1 PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1, PRESSURE <br /> ❑ 3. SUCTION ❑ ]. GRAVITY <br /> CONSTRUCTION, ❑ 1. SINGLE WALL ❑ 3. UNEDTRENCH ❑99 OTHER ❑ L SINGLE WALL ❑95. UNKNOWN <br /> MANUFACTURER2. DOUBLE WALL ❑95 UNKNO", ❑ 2. DOUBLE WALL ❑99. OTHER <br /> MANUFACTURER MANUFACTURER <br /> ❑ 1.BARE STEEL ❑ 5. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ S. FRP COMPATIBLE WI 10%MET <br /> MATERIALS AND ❑ 2. STAINLESS STEEL ❑ T.GALVANIZED STEEL ❑ 3. STAINLESS STEEL <br /> CORROSION ❑ T.GALVANIZED STEEL <br /> PROTECTION ❑ 3. PLASTIC COMPATIBLE W1TM CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLERIBLE(MCPE) - ❑59.OTHER <br /> ❑ 4. FIBERGLASS ❑ B. FLEXIBLE(HOPE) 1199 OTHER ❑ 4. FIBERGLASS ❑ 9.CATHOOIC PROTECTION <br /> ❑ 5. STEELWICOATING ❑ S. CATMOOICPROTECTION ❑ 5. $TEELWICOATING El 95. UNKNOWN <br /> VII.PIPING LEAK DETECTION(Cheek art tRat appy) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING SINGLE WALLPIPING <br /> PRESSURIZED APING(Check a0mu 4,,y): PRESSURIZED PIPING(Check atl Mal apph): <br /> ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST MTH AUT0 PUMP SHUT OFF FOR LEAK, <br /> LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONN ECTION-AUDIBLE AND VISUAL ALARMS <br /> ALARMS EST ❑ 2. MONTHLY 0.2 GPM TEST <br /> PM <br /> 3ANNUAL INTEGRITY TES <br /> ❑ 3. MONTHLY0GTY TEST 101 GPM) 133. ANNUAL INTEGRITY TEST(0.1 GPM) <br /> ❑ . <br /> ❑ L DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS. CONVENTIONAL SUCTION SYSTEMS(Chock art Maf appW: <br /> ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM TRIENtyAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> TEST 101 GPM) ❑ 6. TRIENNIAL INTEGRITY TEST IDA GPM) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' <br /> ❑ T. SELF MONITORING ❑ i. SELFMONITORING <br /> GRAVITY FLOP! GRAVITY FLOW(Chick all fRaf apply): <br /> ❑ 9. BCNNIALINTEGRITY TEST(01 GPM) A <br /> ❑ B. DAILY VISUAL MONITORING <br /> ❑ 9. BIENNIAL INTEGRITY TEST(O.I GPM) <br /> PRESSURIZED PIPING(Chock 0 that apply) SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Chock aI that aypkj): <br /> 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUOISLEANOVISUALALARMS AND <br /> (Chock <br /> aM) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(clock ane) <br /> ,Pro AUTO PUMP SHUT OFF WHEN A LEIKOCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> ❑ B AUTO <br /> SHUT OFF FOR LEAKS.SYSTEM FAILURE ANO SYSTEM <br /> O-S ❑ 6. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION <br /> O <br /> ❑c NO AUTO PUMP SHUT OFF ❑ E. NO AUTO PUMP SMUT OFF <br /> 11 AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF 0R ❑ 11 AUTOMATICLEAKOETECTOR <br /> RESTRICTION <br /> 12 ANNUAL INTEGRITY TEST IC 1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) <br /> SUCDOfkGRAVITY SYSTEM- SUCTIO WGRAVITY SYSTEM: <br /> ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check 0 Mat appty/ EMERGENCY GENERATORS ONLY(Cluck a0 maf apply) <br /> ❑ 14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14. CONTINUOUS <br /> SUMP WITHOUT AUTO PUMP SHUT OFF-AUDIBLE AND VISUAL <br /> VISUALAIAR.M$ <br /> ALARMS <br /> ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) <br /> RESTRICLOn <br /> ❑ 14 ANNUAL INTEGRITY TEST(01 GPM) ❑ 15. ANNUAL INTEGRITY TEST(GI GPM) <br /> ❑ 17. DMLYVISUALCHECK ❑ 1T. OAILYVISUALCHECK <br /> VNL DISPENSER CONTAINMENT <br /> OISPENSER CONTAINMENT 1 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILYVISUALCHECK <br /> DATE INSTALLED ❑ 2.CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCHUNER/MONITORING <br /> ❑ 3. CONTINUOUS DISPENSER PAN SENSOR PITH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑6. NONE <br /> IX.OWNER/OPERATOR SIGNATURE <br /> I une3 mat m auyn pmrke0 Main is Gua aha•mnM m n•Mx a my MPM•C9•. <br /> SIGNATUP E R DATE <br /> NAMED OWN ERATOR ` TITLE OF J` PEMT g� <br /> R <br /> Ppmi114 IN IFabEY wr pnikl P•mtit Appare0(FWbCrl wr <br /> eMy1 Pemx P .�Dxa(Fp/Ittx we oayl <br /> CUPAFORM(4199) <br /> FortneAy SWRCB FotmH <br />