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UNIFIED PROGRAM CONSOLIDATED FORM TAMKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 Pa6e of VI.PIPING CONSTRUCTION(Cnect al low awyf UN)ERGOUHD PIPING ABOVEGROUND PIPING SYSTEMTYFE 0 1. PRESSURE ❑2 SUCTION ❑ 3. GRAVITY 456 ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 459 CONSTRUOTOW ❑ L SINGLE WALL ❑] UNED TRENCH ❑99. OTHER 460 ❑ 1. SINGLE WALL 1195. UNKNOWN 462 MANUFACTURER Fjk2. DOUBLE WALL ❑N. UNKNOWN ❑2. DOUBLE WALL ❑99 OTHER MANUFACTURER 461 MANUFACTURER 410 ❑ 1.BARESTEEL ❑6.FRP COMPATIBLE W/100%METHANO. ❑ i. BARE STEEL ❑ 6. FRP COMPAT16U W71I METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7.GALVANIZEDSTEEL ❑2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASNCCOMPATIBLEWITHCONTENTS 1195. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXIBLE(HDPE) 13 N. OTHER I. FIBERGLASS ❑ 6. FLEXIBLE(HOPE) ❑99. OTHER 114. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING El9 CATHODIC PROTECTION 464 ❑ 5. STEEL WI COATING ❑95. UNKNOWN 465 VII.PIPING LEAK DETECTION(Check al Mal am" UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING AN SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check LI that appy): PRESSURIZED PIPING(CrrX all Nat appy): ❑ L ELECTRONC UNE LEAK DETECTOR 3 0 CPH TEST MTH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE.EAK DETECTOR 3.0 GPH TEST NTH AUTO PUMP SHUT OFF FOR LEAK LEAK SYSTEM FAILURE.AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL SYSTEM FALURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPH TEST ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNU0,LINTEGRITYTEST(0.1GPH) ❑ 3 ANNUAL INTEGRITY TEST(0A GPH) ❑ 4. DAILYVISUALCHET( CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION.SYSTEMS(Check all Mat appy): ❑ S MLYMSUAL MCNITORINGOF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DALYMSUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) ❑ 6. TRIENNIAL INTEGRTY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NOVALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELFMONITORING GRAVITY FLOW GRAVITY FLOW(Check a nal appy): ❑ 9 BIENNkN tNTEGRITYTEST(0i GPH) ❑ S. DALYVISUALMON70RING ❑ 9. BIENNIAL INTEGIbT'TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Cha It all Mat apply) PRESSURIZED PIPING(GMck all incl appy): 10. CONTINUOUS TURBINE SUMP SENSOR N1:a AUDIBLE AND VISUAL ALARMS AND 10, CONTINUOUS TUREINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(o!. (Chaos one) one) ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ A.AUTO PUMP SMUT OFF WHEN A LEAK OCCURS 99a AUTO PUMP DISCONNECTION OFF FOR LEAKS SYSTEM FAILURE AND SYSTEM ❑ 0. AUTO PUMP SHUTOFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNEC'CN ❑ c. NO TOP UMP SHUT OFF ❑ c. NOAUTOP'_VPSHUTOFF ❑ 11. AUTOMATICIC AK LINE LEDETECTOR(]OGP-'EST)'MTH FLOW SHUT OFF OR RESTRICTION ❑ 11. AUTOMATIC LEAs]ETECTOR ❑ 12. ANNUALINTEGRITYTEST(D.IGPH) ❑ 12. ANNUAL INTEGRE"'TEST(0.1 GPHI SDCTIONIGRAVITY SYSTEM: ❑ 13 CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS SUGTIOWLRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that appy) ❑ 14. CONTINUOUS SUMP SENSOR WTHO TAIL 3PUMP SHUT OFF+AUDIBLE AND EMERGENCY GENERATORS ONLY(Check all lnal appy) VISUALALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ❑ 15. AUTOMATIC LINE LEAI(DETECTOR(3.0 GPH-EST)WLTHOUT FLOW SHUT OFF OR ALARMS RESTRICTION ❑ 15. AUTOMATIC UNE ZAK DETECTOR(3.0 GPH TEST) ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17 DALy VISUALCHECK ❑ 16.ANNUAL INTEGR-'TEST(0.1 GPH) ❑ 17. OALYVISUALCHE'K VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MEGIi%t THAT SHUTS OFF SHEARVALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED 466 ❑2. CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER: A tt MONITORING 1 l 7-mm\ ❑ ]. CONTINUOUS='SPENSER PAN SENSOR`NTH AUTO SHUT OFF FOR DISPENSER -_]ISLE AND VISUAL ALARMS ❑ 6. NONE a69 IK OWNER/OPERATOR SIGNATURE Ica [ e aeon OW herein Ia We arc ao:urele Tp Ne Oeat of my xnowledge. SI P= R DATE1'0 NAME OF!7PATGR*bAfflJbo 471 1 TITLED OYNE E-ATOR If 4'2 PamxTNvmeer(ForlpcaIu wq) 473 Fa-e AppmwC(For 1=1 um only) 474 PenIIt ExoIretion Date(For local uae only! I UPCF(1/99) • • Foimedy SWRCB Fr.B