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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 2 TANKS <br /> Vl.PIPING CONSTRUCTION(CNxk nn IMI apph) <br /> UNDERGROUND PIPING <br /> YSTEMTYPE017RF <br /> SSURE 2.SUCTION ABOVEGROUND PIPING <br /> ❑1.GRAYITY 4sx ❑I.PRESSURE 02, SUCTTON 03.GRAVITY 459 <br /> C%)NSTRCCTIOry ®I.SINGLE WALL 1]3.LINED TRENCH 099.OTHER 0.50 ❑ I.SINGLE.WALL <br /> MANUFACTURlR 02.DOUBIF.WAIL 095.UNKNOWN 095.UNKNOWN 4fi3 <br /> MANUFACTURER ❑2.DOUBLE.WALL ❑99.OTHER <br /> 461 MANUFACTURER 463 <br /> 1.HARE SrEFt. 06.FRP COMPATIBLE wpW9k MF IDANOL 01.BARE STEEL <br /> ❑2.STAINLESS STEEL ❑].GALVANIZED STEEL OUNcnOwn ❑6.FRP COMPp77BLE W100.METIIANDL <br /> ❑2. STAINLESS STEEL E]7.GALVANIZED STEEL <br /> 03.PLASTIC COMPATIBLE W/CONTENTS 099. Ol6rr 03. PLASTIC COMPATIBLE W/CONTENTS <br /> ❑4.FIBERGLASS OR.FLEXIBLE(HDPE) ❑R.FLEXIBLE(HDPE.) ❑99. OTHER <br /> ❑4, FIBERGLASS 09.CA THODIC PROTECTION <br /> ❑5.STEEL W.�COATING ❑9.CATHODIC PROTECTION 464 ❑5. STEEL W/COATING <br /> VIL PIPING LEAK DETECTION 112 a kaR lMl 1 pyy, ❑95.UNKNOWN 463 <br /> UNDF.RGROUNU PIPING aPDYI{ illlipn pflR munkorinR pm maMllMau6minw1m11e bcei egy,l <br /> SINGLE WALL PIPING SINGLE WALL PIPING <br /> PRESSURIZED PIPING ICMvk all Ou6Jfi7 <br /> NMYI' PRESSURIZED PIPINGµ'6wk an IMI apphl; <br /> 0 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT <br /> OFF FOR LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION e 0 I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> AUDIBLE AND VISUAL ALARMS. SHUT OFF FON LEAK SYS"TEM FAILURE,AND SYSTEM DISCONNECTION <br /> AUDIBLE AND VISUAL ALARMS. <br /> 0 2.MONTHLY 0.2(!pit TEST 0 2. MONTHLY 0.2 GPH TEST <br /> ❑1.ANNUAL INTEGRO'Y'i'EST(0.1GPIO <br /> ❑1.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 04. DAILY VISUAL.CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS ICheck all IMI apply) <br /> 0 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING <br /> INTEGRITY TEST(0.1 GPH) 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): <br /> ❑6. '!BIENNIAL INTEGRITY TEST(0.1(iPH) <br /> ❑7.SELF MONITORING <br /> GRAVITY FLOWSAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> 0 7. SELF MONITORING <br /> 09.BIENNIAL INTEGRITY TEST B).I GPH) GRAVITY FLOW ICn kale IMI <br /> mphc <br /> 0 R. DAILY VISUAL MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING IChmk oil IMI apply!: PRESSURIZED PIPING(CMck all tlnI apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND Ic'haci,once 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Chink ulx) <br /> On. AUTO PUMP SHUTOFF WHEN A LEAK OCCURS <br /> Ch AUTO PUMP SHUT'OFT FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 6 AUTO PUMP 0 a AUTO PUMP SHUTOFF WHEN A LEAK OCCURS <br /> DISCONNECTION DISCONNECTION <br /> OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM <br /> 0C. NO AUTO PUMP SHUT OFF 0< NO AUTO ECTI SHUTOFT <br /> 011, AUTOMATICLINE LEAK DETECTOR 13B GPH TEST)WITH FLOW SHUT <br /> OFF OR RESTRICTION 0 11. AUTOMATIC LEAK DETECTOR <br /> 012. ANNUAL INTEGRITY TEST(0.I(;Pit) <br /> ❑12. ANNUAL INTFGNITY'fFsl10.1 GPH) <br /> SUCOON/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 013. CON7'IN000S SUMP SENSOR-AUDIBLE.AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR r AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(CL allcMI apply! <br /> 014. CONTINUOUS SUMP SENSOR WITHOUT AU TO PUMP SHUT OFF' EMERGENCY SENSERATORSO AUTO PUMP <br /> PS UT <br /> AUDIBLE AND VISUAL ALARMS ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTT)PUMP SHU'!OFF <br /> 0 15. AUTOMATIC LINE LEAK DETECTOR 0.0 GPH TEST)WITHOU FLOW AUDIBLE AND VISUAL ALARMS <br /> SHUT'OFF OR RESTRICTION 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> 0 16.ANNUAL INTEGRTFY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST 0)1 GPH) <br /> 01]. DAILY VISUAL CHECK <br /> ❑17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 01.FLOA1'MECHANISM THAT SHUI'SOFF SHEAR VALVE <br /> DATE INSTALLED JbR ❑4.DAILY LY V ISUAL CHECK <br /> ❑2.CONTINUOUS DISPENSER PAN SENSOR r pUDIBLF.AND VISUAL.ALARMS ❑5.'lRENCH LINER/MONITORING <br /> 0 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR <br /> DISPENSER+AUDHR F.AND VISUAL ALARMS IJ 6.BONE 469 <br /> IX OWNER/OPERATOR SIGNATURE <br /> I Ct•111(y IMT I orI nl nrUv 1 lµ'Ifq ry IIIM ylb tymm m Illi 63I nrmy kTMIL1IRl. <br /> SIGMA EO F 'Eft/OP RATOR \ _ <br /> DATE 4]0 <br /> 01/19/2010 <br /> FrankDER: R(printl 471 <br /> Flank DaSmaCCi TITLE. OFOWNEN/OPERATOR 912 <br /> Agent for owner <br /> 1`cmm M1'plMv IFor Kcal uw nMyl 413 Pi n,Ih A <br /> pWwd lFnr kcwhl 470 Pmlq G.apinrron llxn•II'aw kcallw•Im1Yl 913 <br /> UPCF(12/99 revised) <br /> Formerly SWRCB Form B <br />