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UNIFIED PROGRAM CONSOLIDATED FORM TANKS DERGROUND STORAGE TANKS -TANK PAGE 2 =C'IlN RU'. ION Cob es al ;iYui' I _ . .. .. Pae of ERGAOUND PIPING SYSTEM TYPE ❑ I. PRESSU ABOVEGROUND PIPING SUCTION ❑ 3. GRAVITY 456. ❑ L PRESSURE O 2. SUCTION CONSTRUCTION/ SINGLE MANUFACTURER ALL [13. GRAVITY 459. ❑ 3. LINED TRENCH ❑ 99. OTHER 460. Q'1. SINGLE WALL ❑ 95. UNKNOWN ❑ 2. DOUBLI 462 WALL Q 95. UNKNOWN ❑ 2. DOUBLE WALL ❑ 99, OTHER MANUFACTU �/f�'J :ii BARE STEEL ❑ 6. FRP 461. MANUFACTURER OMPATIBLE W/100% METHANOL 461 ❑ 1. B ❑ 2. STAINLESS STEEL ❑ 7. GAL ❑ b. FRP COMPATIBLE W/100% METHANOL ANIZED STEEL ❑ 2. STAINLESS STEEL STAINLESS ❑ 3. PLASTIC COMPATIBLE WITH C ONTENTS❑ 7. GALVANIZED STEEL ❑ 95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS 0 4. FIBERGLASS ❑ a, FLE O B. FLEXIBLE (HDPE) 0 99. OTHER IBLE (HDPE) ❑ 99. OTHER C3 1. FIBERGLASS LASS CIS. STEEL W/COATING 0 9. CA ODIC PROTECTION 464. ❑ 5. STEEL TNG O 9. CATHODIC PROTECTION Y7I. TIP.❑ UNDER 95. UNKNOWN 461. ftLEA 'DET ^ ION, d a it 1 Addm lion 66t ro rridshill;Seaobmitred toyam ROUND PIPING b'ggF, - SINGLE WALL PIPING jQ� c ABOVEGROUND PIPING - PRESSURIZED PIPING (Check all that 4/V G-. apply). 466. SINGLE WALL PIPING 467. I. ELECTRONIC LINE LEAK D PRESSURIZED PIPING (Check all that apply); TECTOR 3.0 OPH TEST AM AUTO PUMP El 1. SHUT-OFF FOR LEAK, SYSTE ELECTRONIC LME LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP FAILURE, AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL S. SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION ❑ 2. MONTHLY 0.2 GPH TEST +AUDIBLE AND VISUAL ALARMS. ❑ 3. ANNUAL INTEGRITY TEST (0. ❑ 2. MONTHLY 0.2 GPH TEST 1 GPH) ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS 04. DAILY VISUAL CHECK ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING CONVENTIONAL SUCTION SYSTEMS (Check all that apply) INTEGRITY TEST (0.1 GPH) ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SAFE SUCTION SYSTEMS (NO VALN SYSTEM ES IN BELOW GROUND PIPING): ❑ 6. TRIENNIAL 07. SELFMONITORING INTEGRITY TEST (0.1 GPH) GRAVITY FLOW SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ❑ 9. BIENNIAL INTEGRITY TEST (0 [17. SELF MONITORING I GPH) GRAVITY FLOW (Check all that apply): CIS. DAILY VISUAL MONITORING SECONDARILY CONTAINED MING 09 BIENNIAL INTEGRITY TEST (0.1 GPH) / PRESSURIZED PIPING (Check all "is �Q SECONDARILY CONTAINED PIPING pp ly): N / l0. CONTINUOUS TURBINE SUM PRESSURIZED PIPING (Check all that apply): SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check oro) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ❑ a AUTO PUMP SHUT OFF ALARMS AND (Check oro) N A LEAK OCCURS ❑ Is. AUTO PUMP SHUT OFF FOR ❑ L AUTO PUMP SHUT OFF WHEN A LEAK OCCURS LEAKS, SYSTEM FAILURE DISCONNECTION - AND SYS TEM ❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE Oc. NO AUTO PUMP OF AND SYSTEM DISCONNECTION C311. AUTOMATIC LINE LEAK DE AK D OR (3.0 GPH TEST) WITH FLOW SHUT De NO AUTO PUMP SHUT OFF OFF OR RESTRICTION ❑ l 1. AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST (0.1 PH) SUCTIOWGRAVITY SYSTEM ❑ 12. ANNUAL INTEGRITY TEST (0.] GPH) C113. CONTIN UOUS SUMP SENSOR+ SUCTION/GRAVITY SYSTEM AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check El 13. CONTINUOUS SUMP SENSOR+ all that apply) AUDIBLE AND VISUAL ALARMS y) ❑ 14, CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL EMERGENCY GENERATORS ONLY (Check dl that a 1 AUTO O PUMPSHUT OFF ❑14. CONTINUOUS SUMP SENSOR PP Y) CI IS. AUTOMATIC LINE LEAK D S �AUTO PUMP SHUTOFF TOR (3.0 GPH TEST) WITHO /�T FLOW AUDIBLE AND VISUAL ALARM SHUT OFF OR RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPX 016. ANNUAL INTEGRITY TEST (0.1 TEST) PH) ❑ 17. DAILY VISUAL CHECK ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT Iba. .. 0I- FLOAT MECHANISM THAT DATE INSTALLED SHUTS OFF SHEAR VALVE4. 469. . 02. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 05- �5 TRENCH/LINEDAILY R TRENCWLINER MONITORING 03. CONTINUOUS DISPENSER PAN SENSOR MM AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL LARMS. NONE - ,. Ci`N,'k`.�S:G�1;1' - 71`'A1t�r?A'CClRY•: 1 certify that the information provided It Tein is true and accurate to the best of my knowledge. SIGNA OF ERATOR ' DATE: / no Z S NAME t)� ER/OPERATOR 'int);S L TITLE OF OWNER/OPERATOR: 473. Permit Namber(Agency use coly) 473. Pemut A Loved B A enc ase onl NL PP Y ( B Y Y) q<. Permit Expiration Dale (Agency use o`dY) 475. UPCF hwfwrc-b (1/99) -3/4 httP://www.unidocs.org Rev. 02/16/00