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WUNIFIED PROGRAM CONSOLIDATED FORM ) UNDERGROUND STC GE TANKS - TANK PAGE 2 TANKS +/I.PIPING CONSTRUCTION(Check a1N thataPpy) - UBDERGROUNO PIPING ABOVEGROUND P IMG SYSTEM TYPE ❑ t PRESSURE H 2 SUC•.ION ❑ 3. GRAVITY 458 ❑ 1. PRESSURE ❑Z SUCTION L 3. GRAvitt J59 CONSTRUCTIC 1. SINGLE WALL ❑ 1 LINED TRENCH ❑99 OTHER 460 ❑ 1. SINGLE WALL �y f� ❑9s. UNKNOWN 4621 MANUFACTURER❑ Z DOUBLE WALL ❑9i UNKNOWN ❑ Z DOUBLE WALL rV ❑99. OTHER NUFACTURER 461 MANUFACTURER a63I 1.BARE STEEL ❑ 8. FRP CCMPAT19LE W/100%METHANOL ❑ 1. SARE STEEL ❑ 6. FRP COMPATIBLE W1100%METHANOL MATERIALS AND ❑ Z STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ z STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION ' PROTECTION ❑ 3. PLASTIC COMPATIBLE'MTH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS Q a.FLEXIBLE(HOPEI ❑99. OTHER ❑ 4. Fl9ERGCAS3 ❑ S. FLEXIBLE(MOPE) C399. OTHER Q 4. FIBERGLASS ❑ 9.GTNOOIC PROTECTION ❑ 5. STEEL W/COATING ❑ 9. CATFi(7DIC PROTECTION 46l ❑ 5. STEELW/COATING C2 96. UNKNOWN 465 VIL PIPING LEAK DETECTION(Che 0Matappy) UNDERGROUND PIPING ABOVEGROUND PIPING SNGLE WALL PIPING 486 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Che At that appy): PRESSURIZED PIPING(Check as Mat appy): ❑ 1. 91 ECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. 91-CTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK LEAK SYSTEM FAILURE.AND SYSTEM DISCONNECTION I AUDIBLE AND VISUAL SYSTEMFA6.LIRE,AND SYSTEM DISCONNECTION=AUDIBL.EANOVISUALALARMS ALARMS 13Z MONTHLY 02 GPH TEST ❑ Z MONTHLY GPT TEST ❑ 1 ANNUAL INTEGRITY TEST(0.1 GPHI [3 1 ANNILIL INTETEG TEST(0.1 GPHI �{J ❑ 4. ONLY VISUAL CHECK I CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCRCN SYSTEMS(Check a6 mat aopy). ❑ S. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ S. TRIENNIAL INTEGRITY TEST(0.1 GPM) FE SUCTION SYSTEMS(NO VALVEB IN BELOW GROUND PIPING} SAFE SUCTION SYSTEMS INC VALVES IN BELOW GROUND PIPING): 7. SELFMONRORING ❑ 7. SELF MONITORING GRAVITY FLOW. GRAVITY FLOW(Checkadfhw appy): ❑ S. BIENNIAL INTEGRITY TEST(R/GPH1 ❑ B DAILY VISUAL MONITORING ❑ S. BIENNIAL INTEGRITY TEST(C.1 GPHI SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Checkaa Mat apply): PRESSURIZED PIPING(Check an mat aopy): 10. CONTINUOUS 4V NUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL AND (chNTI ena) WITH iG CONTINUOUS TURBINE SUMP SENSOR AUDIBLE MO VISUALALARMS AND(w= C1A. AUTO PUMP SHUT OFF WHEN A LEU(OCCURS anal ❑ a. AUTO PUMP SHUT OFF MEN ALEAK OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE ANO SYSTEM DISCONNECTION Q It.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ e NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC UNE LEAK DETECTOR 13.0 GPH TESTI WITH FLOW SHUT OFF OR ❑ c NO AUTO PUMP SHUT OFF RESTRICTION ❑ 11,AUTOMATIC LEAK CETECTOR ❑ iz ANNUALINTEGRITYTEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(O.i GPM SUCTICNIGRAV ITY SYSTEM: - ❑ IM CONTINUOUS SUMP SENSOR-AUCIBLEAND VISUALAUIRMS SUCTIONIGRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUALAWRMS EMERGENCY GEPLERATORS ONLY(Chef a901at appy) C3 14. CONTINUOUS SUMP SENSOR wTHOUTAUTO PUMP SHUTOFF*AUDIBLE ANO EMMGENCYGENERATORSONLY(Gleptahthatappy) VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL 13 15.AUTOMATIC UNE LEAK DETECTOR(10 GPM TEST)YYITHDN'FLOW SHAT OFF OR ALARMS RESTRICTION ❑ 15.AUTOMATIC LINE LEAK OEfECTCR(10 GPM TESTI ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUALCHECK ❑ le. ANNUAL INTEGRrrY TEST(mi GPH) ❑ 17. DAILYVISUALOIECK HBI.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THATSMUTS CF'FSHEVt VALVE ❑ 4. 0. LYVISUALCHECK GTE INSTALLED 466 ❑ Z CONTINUOUS DISPENSER PAN SENSOR•AUOIBLE AND VLSUALALARMS ❑ 1 TRENCH UNER/ 6 A + :AONDCRING (V F ❑ 3. CONTINUCUS DISPENSER PAN SENSOR'MTIAUTO SHUT OFF FOR DISPENSER+AUOISLEANOVISUALAIARMS ❑ S. NONE 4tID IS.OMER/OPERATOR SIGNATURE I notNaltapme0anp vqW �q uOue aiq amamem Me creat of ah'unawlea0e. FRE OFk!R T0)R DATE a70 ,ti1,_ a�ou�e a�e�f tz s o iCWNOR(P.W at TITL ERA70 472 c_J i5 a Petmn Numpar(Fwlagl uss pinYl 473 � Perma ApplpVM(Ferlptal asa anrv/ 474 I Pdlpl&mkahpn G9ulfmMml wsapyl al5 UPCF(1/99) - Formerly SVVRCS Form 8