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JNIFIED PROGRAM CONSOL ORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANKS UNDERGROUND PIPING VL PIPING CONSTRUCTION(Check agMw,A,,4 SYSTEM TYPE ❑ 1 PRESSURE cY ASOVEGROUNO PIPING �1�A ❑ Z. SUCTION )0 2 GRAVITY ❑ L PRESSURE CONSTRUCTION/ P 1 SINGLE WALL ❑ 0 LINED TRENCH ❑ 2. SUCTION ❑ 0. MANUFACTURER ❑2 DOUBLE WALL ❑99 OTHER ❑ 1. SINGLE WgLI GRAVITY ❑95. UNKNOWN ❑ 2. DOUBLE WALL FF❑--1I 95. UNKNOWN MANUFACTURER A:u 99:OTHER 1 ' MANUFACTURER 1.BARE STEEL ❑ B. FRP COMPATIBLE W1100%METHANOL CORROSIONMATERIALS AND 2 STSTEEL AINLESS STEEL ❑ 7. GALVANIZED$TEFL ❑ 1' BARE STEEL 13 8. FRPCOMPATISLEW/IDOXMETHANOL PROTECTION ❑ ]. SASTIC INLESS STEEL LE WITH CONTENTS ❑ 2. STAINLESS$TEEL ❑95 UNKNOPM ❑ ]. PLASTIC COMPATIBLE WITH CONTENTS ❑ T G IDUBL (OPE) ❑ a. FIBERGLASS ❑ B. FLEXIBLE(HDPE) ❑99. OTHER, ❑ a, FIBERGLASS ❑ B. FLEXIBLE(HDPE) 11 ❑ ,5.STEEL W/COATING [3 ❑9. CATHODIC PROTECTION S. STEEL W/ ❑ 9. CATMODICPROTECTION OTHER g9 VII.PIPING LEAN DETECTION(Ch,,,aptM., 95. UNKNOWN fAsf a Pyl ❑ SINGLE WALL PIPING UNDERGROUND PIPING PRESSURIZED PIPING(DMLk&#,hat aP>M2 ABOVEGROUND PIPING ❑ W I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SMUT OFF FOR PRESSURIZED PIPING(Ch« SINGLE ALL PIPINGk aU foal appy): - LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION.AUDIBLE AN VISUAL ❑ 1. ELECTRONIC LINE LEAK DETECTOR 30 GPM TESTWITH AUTO PUMP SHUT OFF FOR LEAK, A`hREIS SYSTEM FAILURE,AND SYSTEM OISCONNECTION•AU0AU018LE AND VISUAL ALARMS ❑ 2. MONTHLY 0 2 GPX TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ ] ANNUAL INTEGRITY TEST(01 GPM) ❑ ].ANNUAL INTEGRITY TEST IDA GPM) CONVENTIONAL SUCTION SYSTEMS: ❑ a. DAILY VISUAL CHECK ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM*TRIENNIAL PIPING INTEGRITY ❑NVENTIONAL VISUSUCTION ONSYSTEMO(Chek"t& tNG PUMPING*)): SYSTEM TEST III 1 GPM) SAFE SUCTION SYSTEMSINO VALVES IN BELOWGROUNO PIPING) ❑ 8. TRIENNIAL INTEGRITY TEST(0.1 GPM) ❑ T SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITYFLOW ❑ T SELF MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GRH) GRAVITY FLOW(Cn kaX that appty) ❑ B. DAILY VISUAL MONITORING SECONDARILY CONTAINED PIPING C19 BIENNIALINTEGRITYTEST(O.IGRH) PRESSURIZED PIPING(G«k afl Maf apply); 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND PRESSURIZED PIPING(Check efl Pat±ECONDARILY CONTAINED PIPING ICceck onq PP'Y) ❑ a AUTO PUMP SHUT OFF MEN A LEAK OCCURS 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(cneck one) ❑ h AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ a AUTO PUMP SHUT OFF MEN LEAK OCCURS DISCONNECTION ❑ < NO AUTO PUMP SHUT OFF ❑ h. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION . ❑ 11 AUTOMATIC LING LEAK DETECTOR ID.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ c, NO AUTO PUMP SMUT OFF Z A RESTRICTION ❑ 11 AUTOMATIC LEAK DETECTOR ❑ 1MNALINTEGRITY TEST IDI GPHI SUCTION-GRAVITY SYSTEM ❑ 12. ANNUAL INTEGRITY TEST IDA GPH) ❑ 13 CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS SUCTION/GRAVITy SYSTEM: EMERGENCY GENERATORS ONLY(CT)«k an Pat appy/ ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ ta. CONTINUOUS SUMP SENSOR VATHOUT AUTO PUMP SHUT OFF a AUDIBLE AND EMERGENCY GENERATORS ONLY(Ch«k aA thatmppry) VISUAL ALARMS ❑ Ia.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE ANO VISUAL ❑ 15 AUTOMATIC LINE LEAK DETECTOR(].O GPM TEST) FLOWSHUTOFFOR ALARMS RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPX TEST) ❑ 1E. ANN-JAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILYVISUALCHECK ❑ 18 ANNUAL INTEGRITY TEST III I GPM) ❑ P. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTOFF$HEAR VALVE OATEINSTALLEO ❑ 2. CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑_,/Ag' DAILY VISUAL CHECK ❑ ]. CONTINUOUS DISPENSER PAN SENSOR WITM AUTO SHUT OFF FOR DISPENSER AUDIBLE AND VISUAL ALARMS 1Y 8. NONE LINER/MONITORING I imy PM Pe mVwmauon ProVlpaO narein H hue arq awulna Ia Pa haM 01 my MaMea9e.Z OWNER/OPESIGNATURE SIGNATUREOF ER/Op RAI_R t .a DATE NAMES OOF OWN OPERATOR/phMJ E O 2 Awl r, ,kplD W 4t TITLE OFGMERYOPERATOR Partnit NumOar(Fw l«a/waaVxyl PalmitA ppmvaA(Forbin we on/yl Pertnp Eap'va9on pate(Fprbcal ms aHyl CUPAFORM(6199) Formerly SWRC8 Form 8