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` UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION Checkall mau I page of_ <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE Z.PRESSURE D 2.SUCTION D 3.GRAVITY 458 D 1.PRESSURE D 2. SUCTION D 3.GRAVITY 459 <br /> CONSTRUCf1ON Er I.SINGLE WALL D 3.LINED TRENCH [199.OTHER 460 D 1.SINGLE WALL D 95.UNKNOWN 46x <br /> MANUFACTURER 62.DOUBLE WALL D 95.UNKNOWN D 2.DOUBLE WALL D 99.OTHER <br /> MANUFACTURER 461 MANUFACTURER 461 <br /> ❑I.BARE STEEL D 6.FRP COMPATIBLE w/100% METHANOL D 1.BARE STEEL D 6.FRP COMPATIBLE W/loo%METHANOL <br /> D 2.STAINLESS STEEL D 7.GALVANIZED STEEL D Unknown D 2. STAINLESS STEEL D 7.GALVANIZED STEEL <br /> D 3.PLASTIC COMPATIBLE W/CONTENTS D 99. Other D 3. PLASTIC COMPATIBLE W/CONTENTS D S.FLEXIBLE(HDPE) D 99. OTHER <br /> K4.FIBERGLASS D 8.FLEXIBLE(HDPE) [14. FIBERGLASS D 9.CATHODIC PROTECTION <br /> D 5.STEEL W/COATING D 9.CATHODIC PROTECTION 464 D S. STEEL W/COATING D 95.UNKNOWN 465 <br /> VIL PIPING LEAK DETECTION(Checkall maze I Adem rahmcfthe-.jldg ptomanoholl beaabmined to the local <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Checkout thn apply): PRESSURIZED PIPING(Check all that apply). <br /> D 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT D 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 /> D 2.MONTHLY 01 GPH TEST [12. MONTHLY 0.2 GPH TEST <br /> D 3.ANNUAL INTEGRITY TEST(0.1 GPH) [13.ANNUAL INTEGRITY TEST(O.1 GPH) <br /> [14. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> D 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING D 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): D 6. TRIENNIAL INTEGRITY TEST(0.1 GPID <br /> D 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW D7. SELF MONITORING <br /> D 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all mat apply): <br /> Cl 8. DAILY VISUAL MONITORING <br /> D 9. BIENNIAL 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 WI AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ARMS AND(Check one) ALARMS AND(Check one) <br /> a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS D a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> Cl It. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM D It AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> �[ Dc. NO AUTO PUMP SHUT OFF Dc NO AUTO PUMP SHUT OFF <br /> f61 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT <br /> OFF OR RESTRICTION 11 AUTOMATIC LEAK DETECTOR <br /> D 12. ANNUAL INTEGRITY TEST(0.1 GPH) [112. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> D 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> [114. CONTINUOUS SUMP SENSOR WITH AUTO PUMP SHUT OFF" Cl 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF" <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> D 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW <br /> SHUT OFF OR RESTRICTION 15. AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST) <br /> D 16.ANNUAL INTEGRITY TEST(0.1 GPH) D 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> D 17. DAILY VISUAL CHECK D 17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT �❑/1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE D 4.DAILY VISUAL CHECK <br /> DATE TALLED 468 RI 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING <br /> 'IGJ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR [16.NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> Ircralythatthem rionpmvid heminist eudacwmwtomebwafmyknDwiedgc. <br /> SIGNATU OF Q PE DATE / 470 <br /> N TO i <br /> % rot 471 ITLE OF OWNERA PERA OR 472 <br /> Permit Number(For local me only) 473 Permit Appmot,d(Far local useanly) 474 Pmmit Expiration than,(For local too only) 475 <br /> UPCF(12/99 revised) 12 Formerly SWRCB Form B <br />