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dct 23 06 12: 11p owner 209:41 -C142 p. 5 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS- TANK PAGE 2 <br /> Page of <br /> YL PIPING CONSTRUCTION iiii: <br /> UhDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 01.PRESSURE 02.SUCTION Q3.GRAVITY 458. Q1.PRESSURE 02.SUCTION 03.GRAVITY 459 <br /> CONSTRUCTION/ 01.SINGLE WALL 03.LINED TRENCH Q99.OTHF.R 460. QLN <br /> SINGLE WALL ❑95.UNKNOW452 <br /> MANUFACTURER 2 DOUBLE WALL 095.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER <br /> MANUFACTURER 461. MANUFACTURER 463 <br /> 0 I.BARE STEEL 0 6.FRP COMPATIBLE W/100%METHANOL Q 1.BARE STEEL 0 6.FRP COMPATIBLE WWII%METHANOL <br /> [12.STAINLESS STEEL 0 7.GALVANIZED STEEL Q 2.STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> Q 3.PLASTIC COMPATIBLE WITH CONTENTS ❑95.UNKNOWN 0 3.PLASTIC COMPATIBLE W'/CONTENTS Q 8.FLEXIBLE(HOPE) 0 99.OTHER <br /> rI�$4.FIBERGLASS O S.FLEXIBLE(TIDPE) 099.OTHER Q4.FIBERGLASS 09.CATHODIC PROTECTION <br /> f 5 STEEL W/COATINO ❑9.C.4,7SODF^PROTECTION 4M. ❑S.STEEL W/COATING 0 95.UNKD'OWB 465. <br /> W.PIPING LEAK DETECTION(Ch9k 99 ft xme otOntm6;oF am atanbe svtm'evntouelmt <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467. <br /> PRESSURIZED PIPING(m«k all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 0 1. ELECTRONIC LINE LEAK DETECTOR.3.0 GPH TEST WITH AUTO PUMP 0 L ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> SHUT-OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNEC71ON SHUT OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION <br /> +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. <br /> 02. MONTHLY 0.2 GPH TEST Q 2. MONTHLY 0.2 GPH TEST <br /> 03. ANNUALNTEGRITYTEST(O.IGPH) 03. ANNUALINTEGRITY7E91'(0AGPH) <br /> 0 4. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> 0 S. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 05. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> NTEGRITV TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 06. TRIENNIAL INTEGRITY TEST(0.I GPH) <br /> [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRA<•TTV FLOW 07. SELF MONI T'ORING <br /> 09, BIENNIAL INTEGRITY TEST((yl GPH) GRAVITY FLOW(Checkull tluuwly): <br /> 1--18. DAILY VISUAL MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTALNED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Cbak all Nat apply): PRE99UPJZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check ove) ALARMS AND(Check ow) <br /> 0 a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a.AUTO PUMP SHAT OFF WHEN A LEAK OCCURS <br /> 0 b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM Q b.AUTO PUMP SHUTOFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNT3CT)ON DISCONNECTION <br /> Dc. NO AUTO PUMP SHUT OFF Dc. NO AUTO PUMP SNRT OFF <br /> 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 0 I1 AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> ❑12. ANNUAL INTEGRITY-EST(0.1 GFH) 012.ANNUAL INTEGRITY TEST(0.1 GFH) <br /> ',=ONtGRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL ALARMS OU.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Cbeckall that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> Q14. CONTINUOUS SUMP SENSOR WTTHQ AUTO PUMP SHUT OFF Q14,CONTINUOUS SUMP SENSORWITHOUT AUTOPUMPSHU'r OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> 015. AUTOMATIC MME LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW 015.AUTOMATIC LINE LEAK DETECTOR(10 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> 016, ANNUAL-NTEGIUTYTEST(O.l GPI{) 016.ANNUAL INTEGRITY TEST III GPH) <br /> Q 17, D V-,1 VISUAL CHECK 0 17.DAILY VISUAL C=IECK <br /> VIII.DISPENRERCONTAMN[ENT <br /> DISPENSER CONTAINMENT 46a. t:,L FLOATMECHANISM THAT SHUTS OFF SHEAR VALVE Q4. DAILY VISUAL CHECK 469. <br /> DATE INSTALLED 62. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 05. TRENCWLINERMONITORING <br /> 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SMUT OFF FOR <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6. NONE <br /> IX.OWNER/OPERATOR SIGNATURE <br /> I twaify that the information provided hettan's nuc and accurate to he best of my knowledge. <br /> SIGNATl1RE OF OWNRATOR DATE: 470_ <br /> l0 G•C <br /> NAME OFOWNER/OP R(priot: TITLE OF OWNER/GPERATOR: 472 <br /> 7J DL E <br /> Pemdt Nomber(Agency me only) 473 1 Permit Approved By(Agony nm only) 474. PQvdt Expiation Dan(Agency nse ontyl 475. <br /> 1JPCF hwfwre-b(1/99)-3l4 MtP://www.unid"Lorg Rey.02/16/00 <br />