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NIFIED PROGRAM CONSOLIDATED F010W <br />I Qe 16 *7 <br />TANKS <br />UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br />Pae of <br />VL PIPING CONSTRUCTION Cheek <br />all dura I) <br />UNDERGROUND PIPING <br />ABOVEGROUND PIPING <br />SYSTEM TYPE . PRESSURE [12. SUCTION D 3. GRAVITY 458. <br />0 1. PRESSURE 0 2. SUCTION 0 3. GRAVITY 459. <br />CONSTRUCTION/ D 1. NGLE WALL 0 3. LINED TRENCH [199. OTHER 460. <br />[11. SINGLE WALL <br />D 95. UNKNOWN 4a <br />MANUFACTURER L DOUBLE WALL 0 95. UNKNOWN <br />D 2. DOUBLE WALL <br />❑ 99. OTHER <br />MANUFACTURER r <br />461. MANUFACTURER' <br />❑ 1. BARE STEEL 0 6. FRP COMPATIBLE W1100% METHANOL <br />0 1. BARE SEL <br />D 6. FRP COMPATIBLE W/100% METHANOL <br />❑ 2. STAINLESS STEEL D 7. GALVANIZED STEEL <br />D 2. STAINLESS SEL <br />0 7. GALVANIZED STEEL <br />0 99. OTHER <br />DSTIC COMPATIBLE WITH CONTENTS 0 95. UNKNOWN <br />D 3. PLASTIC COMPATIBLE W/ CONTENTS <br />D 8. FLEXIBLE (HDPE) <br />4. FIBERGLASS D 8. FLEXIBLE (HDPE) 099. OTHER <br />[14. FIBERGLASS <br />[19. CATHODIC PROTECTION <br />❑ 5. STEEL W/COATING [19. CATHODIC PROTECTION 464_ <br />D 5. STEEL W/COATING <br />D 95. UNKNOWN 465. <br />SINGLE WALL PIPING 466 <br />PRESSURIZED PIPING (Check all that apply): <br />0 1 ELECTRONIC <br />ESSDETECTOR 3.0 OPH SDI AUTO PUMP <br />SHUT-OFF FOR AK, TEM FAILURE. AND SYSTEM DISCONNECTION <br />DISCONNB +AUDIBLE AND VISUAL ALARMS. <br />[12. MONTHLY 0.2 GPH TEST <br />[13. ANNUAL INTEGRITY TEST (0.1 GPH) <br />CONVENTIONAL SUCTION SYSTEMS <br />05. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING <br />INTEGRITY TEST (0.1 GPH) <br />SAFE SUCTION SYSTEMS MO VALVES IN BELOW GROUND PIPING): <br />[17. SELF MONITORING <br />GRAVITY FLOW <br />[19. BIENNIAL INTEGRITY TEST (0.1 GPU) <br />SECONDARILY CONTAINED PIPING <br />PRESSURIZED PIPING (Check all that apply): <br />10. CONTINUOUS TURBINE SUMP SENSOR WFrH AUDIBLE AND VISUAL <br />ALAWS AND (Check one) <br />grrUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM <br />DISCONNECTION <br />/ <br />Cc. NO AUTO PUMP SHUT OFF <br />11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT <br />J <br />,.,/^ OFF OR RESTRICTION ANNUAL INTEGRITY TEST (0.1 GPH) <br />SUCTION/GRAVITY SYSTEM <br />[113. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS <br />EMERGENCY GENERATORS ONLY (Check all that apply) <br />[114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br />AUDIBLE AND VISUAL ALARMS <br />015. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUTPLOW <br />SHUT OFF OR RESTRICTION <br />. ANNUAL INTEGRITY TEST (0.1 GPH) <br />017. DAILY VISUAL CHECK <br />SINGLE WALL PIPING 467' <br />PRESSURIZED PIPING (Check all that apply): <br />D 1 <br />SHUT PI <br />FLEAK, AK, SYSTEM FAILC LINE LEAK URE, 10 P <br />URE AND SYSTEM H TEST =DISCONNECTION <br />+AUDIBLE AND VISUAL ALARMS. <br />D 2. MONTHLY 0.2 GPH TEST <br />03. ANNUAL INTEGRITY TEST (0.1 GPH) <br />D 4. DAILY VISUAL CHECK <br />CONVENTIONAL SUCTION SYSTEMS (Check all that apply) <br />[15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br />E16. TRIENNIAL INTEGRITY TEST (0.1 GPH) <br />SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): <br />E17. SELF MONITORING <br />GRAVITY FLOW (Check all that apply): <br />0 S. DAILY VISUAL MONITORING <br />0 9. BIENNIAL INTEGRITY TEST (0.1 GPH) <br />SECONDARILY CONTAINED PIPING <br />PRESSURIZED PIPING (Check all that apply): <br />10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br />ALA S AND (Check one) <br />UTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM <br />DISCONNECTION <br />Cc. NO AUTO PUMP SHUT OFF <br />0a11.1.. AUTOMATIC LEAK DETECTOR <br />mo ANNUAL INTEGRITY TEST (0.1 GPH) <br />W6, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS <br />EMERGENCY GENERATORS ONLY (Check all that apply) <br />0 14. CONTINUOUS SUMP SENSOR WITH AUTO PUMP SHUT OFF <br />AUDIBLE AND VISUAL ALARMS <br />[115. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) <br />[116. ANNUAL INTEGRITY TEST (0.1 GPH) <br />[117. DAILY VISUAL CHECK <br />DISPENSER CONTAINMENT 468. DI. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE D4. DAILY VISUAL CHECK 469, <br />DATEINSTALLED 02 CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS E15. TRENCH/LINER MONITORING <br />91 / e0 i CONTTNUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR [16. NONE <br />i c at the infottnation pmvidedJicP&k 94PV and accurate to the best of my knowledge t Ova <br />DATE: /O / 17 /D <br />471. I PCT <br />UPCF hwfwre-b (1/99) - 314 www.unidocs.org Rev. 02/16/00 <br />