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r * RECEIVED UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGJOvlo, _,•,; l i :,: ,. . ; r AL VI.PIPrNG CONSTRUCTION a.wt ' iii of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEMTYPE ❑L PRESSURE 0.2-SUCTION ❑3.GRAVTIY 42 ❑1.PRESSURE ,T. SUCr10N ❑3.GRAVITY 459 CONS UCIION.k.SINGLE WALL ❑3.LINED TRENCH ❑49.OTHER 44Z .SINGLE WALL (]95.UNKNOWN 4m MANUFACfUAPR❑2.DOUBLE WALL ❑95.UNKNowN G 21)OUBLE WALL ❑99.OTHER MANUFACTURER N �N(1W 46I MANUFACTURER 16 ❑1.BARE STEEL ❑6.FRP COMPATIBLE w/t0o9c teEfIL�NOL ❑1.BARE STCEL ❑6.FRP COMPATIBLE WnoaX MfI11ANOL [12-STAINLESS STEEL 4 GALVANIZED STEEL )TUv1v9w0 ❑2.STAINTPSS STEEL ❑7.GALVANIZED STEEL Q 3.PLASTIC COMPATIBLE W/CONTENTS 1199.Olhv ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑S.FLEXIBLE(HDPE) ❑99.OTHER t14.FIBERGLASS ❑S.FLEXIBLE(HDPE) ❑4.FMEROLA.S.S ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 464 ❑5.STEEL W/COATA'o ❑95.UNKNOWN q65 VIL PIPING LEAKDETECTIONwmu A ®otOmmodlvdn .b.0 bv.vbmiuc4 wlh.bu]• UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING 467 PRESSURIZED PIING(C W W'.ppy): PRESSURIZED PIPING(CM4.B Oul.pply): ❑1.PI.ECTi(ONIC LINE LP.UCDITECIT)R 3.0 OPH TEST YIJ?1j AUTO PUMPSHUT ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST W AUTO PUMP OFFFOALI+AR,SYSI7'M FAILUR$AND SYSTEM D75CONNEC710N+ SHUT OFF FOR IFAK SYSTEM FAILUAE;AND SYSTEM DISCONNECTION+ AUD®LP AND VISUAL ALARMS. A(B)IBLE AND VISUAL ALARMS. ❑2.MONTHLY o2 GPH TEST ❑2.MONTHLY 02 OPH TEST ❑3.ANNUAL INTEGRITY TEST(o.IOPH) ANNUAL IMEGRI7Y TEST(0.1 OPH) 4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Clwet W Wl.pply) ❑5.DAILY VISUAL MONITORING OF PIMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPM ❑5.DAILY VISUAL MONTTCRTNO OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6.TEEINNIAL INTEGRITY TEST(0.1 GPI). SaY MOMTORINO SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVTIYFLOW ❑7.SELF MONITORING Cl 9.BIENNIAL INTEGRITY TEST(0.1 GPH) WAVTTYFLOW(Ch k.INWl.wy): . ❑S.DAILY VISUAL MONITORING ❑9.BIENNIAL Dn EoRTrY TEST(0.1 OPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Ch. am .yply): PRESSURIZED PIPING(CIw4.0 uv..pply): 10.CONTINUOUS TURBINE SUMP SENSORYM AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(CTWc9m) ALARMS AND([Mato.) ❑. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 13-AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b.AUTO POMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FORLEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑c. NO AUTO FUMP SHUT OFF ❑c NOAUTOPUMP SHUT OFF 1111. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) '$M FLOW SHUT OFF OR RESTRICTIONAft 11.AUTOMATICLPAKDETECTOR ❑12. ANNUAL INTEGRITYTEST(0.1 GPH) ❑12 ANNUAL 1NTPGRTIY TEST(0.1 GPH) SUCTIONlGRAVRY SYSTEM SUCTION/GRAVTrYSYSmM 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Che W0 gply) EMERGENCY GENERATORS ONLY(Che WI tmpNy) 0MCONITN000SSUMPSENSORWIT1101I[AUTOPUMPSHUTOFF• ❑14.CONTINUOUS SUMP SENSOR}]ITHQU AUTOPUMPSHUTOFF• AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 0.15.-AUTOMATIC LANE LEAK DETECTOR(3.0 OPH TEST)WrrHoj FLOW SHUT OFF ORRESTRICTION ❑15.AUTOMATIC LINE LEAK DETECTOR(3.o GPH TEST) ❑16.ANNUAL INTEGRITY TESL(0.1 GPI) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑17.DAILY VISUAL CHECK ❑17.DAILY VISUAL CHECK :VII.DISPENSER CONTAWdENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTAUM49 02.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLEAND VISUAL ALARMS 05.TRENCH LINER/MONITORING ❑3.CONTINUOUS DISPENSERPAN SENSOR ME AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARM ❑6.NONE 40 DL OWNER/OPERATOR SIGNATURE t9atiy LLu Oamf rim Iv®ia vu.md.mv.waNbv bn.n(mytrov4dt< ONAP*r t+r DATE � 4N1 NW OFD v T n. 4n IDLE OF WNEIUO 70Jj an .� + l ( ✓LL t N� L4.�1 Ci C. Parch NumNr(F*kcw9..my) -473 Pa Appm (F.I W ..Wy) 4'74 Pmdtl+spu.4m Dve o-leN io.odY) 47: UPCF(12199 revised) 12 Formerly SWRCB Form B