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Jul 13 2006 6: 26PM Rage Environmental , Inc (91354-1786 p. 4 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 aaaaaaaa Of UNDERGROUNDPIPING ABOVEGROUND PIPING.. NA SYSTEM TYPE C L PRESSURE 0 2.SUCTioN 03.GRAVITY 458. C 1.PRESSURE 0 2,SUCTION C 3.GRAVITY 459 CONSTRUCTION/ to 1,SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460. 0 1•SINGLE WALL 0 95.UNKNOWN 462 MANUFACTURER 0 2.DOUBLE WALL 0 95.UNKNOWN 0 2 DOUBLE WALL 0 99,OTHFR MANUFACTURER - UNKaW Ii MANUFACTURER - NA 463. L BARE STEEL 06.PRP COMPATIBLE W/10090 METHANOL 01.BARE STEEL 06.FRP COMPATIBLE W/100/S METHANOL ❑2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 2.STAINLESS STEEL C 7.GALVANIZED STFPL ❑3 PLASTIC COMPATIBLE WITH CONTENTS C 95.UNKNOWN C 3.PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEXIBLE(HDPE) 0 99.OTHER C 4.FIBERGLASS 0 S.FLEXIBLE(HDPE) 0 99.OTHER 0 4.FIBERGLASS 0 9.CATHODIC PROTECTION 0 S.STEEL WICOATING 0 9.CATHODIC PROTECTION 4a. 0 5.STEEL WTAATING 0 95,UNKNOWN 465 MDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING - N O N IE 466. SINGLE WALL PIPING - N A 467. PRESSURIZED PIPING(Check all dw apply): PRESSURFZED PIPING(Check all that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT-OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION 4 AUDIBLE AND VISUAL ALARMS. .. - _ _.... +AUDIBLE AND VISUAL;ALARMS,, [12. MONTHLY 02 GPH TEST 02. MONTHLY 0.2 GPH TEST [13. ANNUAL INTEGRITY TEST(0.1 OPH) 03. ANNUAL INTEGRITY TEST(0.1 GPH) C 4. DAILY VISUAL CHECK CONVENTIONAL.SUCTION SYSTEMS CONVENTIONAL STICTION SYSTEMS(Check as thin apply) [35. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING [35.INTEGRITY TEST(0.1 GPH) 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAPS SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 06. TRIENNIAL INTEGRITY TEST(0.1 GPH) 07. SELFMOMTORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW OROTUND PIPING): GRAVITY FLOW 0 7. SELF MONITORING [39 BIENNIAL INTEGRITY TEST(0.1 OPH) GRAVITY FLOW(Check all that apply): 138. DAILY VISUAL MONITORING E39. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING - SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all Ilan apply): PRESSURIZED PIPING(CbNk all that apply); I0. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTMOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check am) ALARMS AND(Check ane) ❑a.AUTO PUMP SPRIT OFF WHEN ALEAK OCCURS 0 e AUTO PUMP SHUTOFF WHEN A LEAK OCCURS ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM C b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION 0c. NO AUTO PUMP SHUT OFF 0c. NO AUTO PUMP SHUTOFF 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT C I1 AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. ANNUAL INTEGRITY TESL(0.1 OPH) SUCRONICRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 0 13. CONTINUOUS SAIF SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Chink all that apply) (214. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 0 14. CONTBATIOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS [115. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW C 15AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST) SHUT OFF OR RESTRICTION 0 16. ANNUAL INTEGRITY TEST(0.1 GPM) 0 16.ANNUAL INTEGRITY TEST(0.1 CRH) [117, DAILY VISUAL CHECK ❑17. DAILY VLSUALCHWK :.i". '...' _ v .I')P 13�1a::.1..d i' RI..�s•.^. .n ,. .r}.�'k YY3i'iu^�IB.n .. .4 (�''_3'tc. e - '' . 1�s l'::: DISPENSER CONTAINMENT 464 0 1. AT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4.YwDAILY VISUAL CHECK '• 469 DATE INSTALLED NA [32, CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS C 5. TRENCIVLINER MONITORING 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUTOFF FOR. 06, NOTE DISPENSER+AUDIBLE AND VISUAL ALARMS I certify that the information provided herein is true and acculam w the best of my knowledge. STC!NvruRE OF OWNEFWY.RATOR DATE: 470. 6- -Ow N OF O PERATOR(print): TITr�E'OF Q PERA R / 3 471 a HSS) 4Y 2a�vr Ad t/A F_y we7f Pamut Namba (Ageary nae Daly) ala. P-1 Appmved By(Agency aaa m4y) s74. Pennh Expiraem Dam(Agency nae aNy) 475. UPCF hwfwr b(1/99)-3/4 bttin/wwwmaidocs org Rev.OV16100