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UNIFIED PROGRAM CONSOLIDATED FORM <br /> a TANKS <br /> a UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Che knit mat. 1 Page of_ <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE NIL PRESSURE 0 2.SUCTION 0 3.GRAVITY 458 0 1.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 <br /> CONSTRUCTION Cr 1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 [11.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACTURER &2.DOUBLE WALL 0 95.UNKNOWN [12.DOUBLE WALL C 99.OTHER <br /> MANUFACTURER461 MANUFACTURER 463 <br /> 0 1.BARE STEEL 0 6.FRP COMPATIBLE W/m0% METHANOL 0 I.BARE STEEL 0 6.FRP COMPATIBLE W/100%METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 Unknown 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 03.PLASTIC COMPATIBLE W1 CONTENTS 099. Other 03. PLASTIC COMPATIBLE W/CONTENTS ❑B.FLEXIBLE(HDPE) 099. OTHER <br /> K4.FIBERGLASS. 0 8.FLEXIBLE(HDPE) [14. FIBERGLASS ❑9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING [19.CATHODIC PROTECTION 4M 0 5. STEEL W/COATING ❑95.UNKNOWN 45 <br /> VIL PIPING LEAK DETECTION Chock all that a A deocri tion at the monitoring shot)be submitted to the local gent .) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Gawk all that apply): <br /> ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT Cl 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> 0 2.MONTHLY 02 GPH TEST 02. MONTHLY 0.2 GPH TEST <br /> 0 3.ANNUAL INTEGRITY TEST(0.1GPH) 0 3.ANNUAL INTEGRITY TEST(O.IGPH) <br /> [14. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chock all that apply) <br /> [15.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELF MONITORING <br /> 0 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Chock all that apply): <br /> 0 8. DAILY VISUAL MONITORING <br /> 0 9. 131ENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Check one) <br /> a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 g AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 Is. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> �( Oc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> VJ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 0 <br /> OFF OR RESTRICTION 11.I AUTOMATIC LEAK DETECTOR <br /> / <br /> 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALAR MS <br /> EMERGENCY GENERATORS ONLY(Chock all that apply) EMERGENCY GENERATORS ONLY(Chink all that apply) <br /> 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF [114. CONTINUOUS SUMP SENSOR WITH 011T AUTO PUMP SHUT OFF' <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> [116,ANNUAL INTEGRITY TEST(0.1 GPH) [116.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 017. DAILY VISUAL CHECK 017. DAILY VISUAL CHECK <br /> VOL DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT [11.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK <br /> DATE TALLED 469 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING <br /> 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE 969 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> 1 ccnify that the in ation provided herein is true and accurate to the best ofmy knowledge. <br /> SIGNATU OF E PE DATE 470 <br /> N TO rin[ 471 ITTLE OF OWNER/OPERA OR 472 <br /> S <br /> Permit Number(For local use only) 473 Permit Approved(For local use only) 474 Permit Expiration Date(For local use only) 475 <br /> UPCF(12/99 revised) 12 Formerly SWRCB Form B <br />