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IED PROGRAM CONSOLIOATEO FO <br />TANKS <br />UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br />VL PIPING CONSTRUCTION IG ae BW appq <br />Pmme APPIeraE <br />u owD9 <br />CUPA0ORM (4199) • FOmK.Rry SVVRCR Farm 8 <br />ABOVEGROUND PIPING <br />UNDERGROUND PIPING <br />SYSTEM TYPE ❑ 1 PRESSURE ❑ 2. iUCTION ❑ 3. GRAVITY I <br />❑ 1. PRESSURE ❑ L SUCTION ❑ 3. GRAVITY <br />❑ 1. SINGLE WALL \�❑'1 IJ NED TRENCH ❑99. OTHER <br />❑ L SINGLE'NALL ❑95. UNKNOVM <br />CONSTRUCTIOW <br />MANUFACTURER <br />❑ L DOUBLE WALL E.19S UNKNOWN <br />❑ L OOUSLE'NALL ❑ N. OTHER <br />MANUFACTURER <br />.MANUFACTURER <br />OMPATIBLE `M 100% METHANOL <br />❑ 1. 3ARE STEEL ❑ S. PRP COMPATIBLE' <br />❑ 1. BARE STEEL ❑ d. FRP COMPATIBLE`? 100% METHANOL <br />MATERIALS AND <br />❑ 2. STAINLESS STEEL ❑ T. WLVAM2ID STEE� <br />❑ 2 STAINLESS STEEL. ❑ 1. WLVANIZED Sim <br />CORROSION <br />❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 95. UNKNOWN <br />❑ 3, PLASTIC COMPATIBLE VAT?CONTcNTS ❑ S. FLEXIBLE (MOPE) 98. OTHER <br />PROTECTION <br />❑ s. FIBERGLASS ❑ 5 r- BLE(HOPE) ❑99. OTHER <br />❑ A. FIBERGLASS ❑ 9. CATHODIC PROTECDCN <br />❑ 5. STEEL WI COATING ❑ 9. CATHODIC PROTECTION 1 <br />❑ 5. STEEL'M COATING 1:195. UNKNOWN <br />VII. PIPING LEAK GET EC 10N (DDMPK a/ mM em9T <br />UNOERGPOUNO PIPING <br />ABOVEPIPING <br />iGLE LEWALL WALL PIPING <br />W <br />SINGLE WALLPIPING <br />PRESSURIZED PIPING <br />P0.ESSURIL'O PIPING (CSePA all mal aPPNI: <br />ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST W1TM AUTO PUMP SHUT OFF FOR <br />❑ I. INE(CNE KMal ECTO <br />3.0 GPM TEST`MTM AUTO AND VI SMUT OFF -0R LEAK <br />❑ 1. ELECTRONIC UNE LEAK SYSTEM <br />SYSTEM FAIWRE AND SYSTEM OISCONNECrIOn•AUDIBLE AND VISWLALARNS <br />LEAK. SYSTEM FAILURE AND SYSTEM DISCONNECTION •AUDIBLE AND VISUAL <br />ALARMS <br />❑ 2 MONTHLY 0.2 GPI/ TEST <br />❑ L .MONTHLY 0.2 GPM TEST <br />❑ 1 ANNUAL INTEGMTY TEST (0.1 GPM) <br />❑ 1 ANNUAL INTEGRITY TEST (0-1 GEN) <br />❑ a. OAILYVISUALCHECK <br />CONVENTIONAL SUCTION SYSTEMS lCm ae mr awM: <br />CONVENTIONAL SUCTION SYSTEMS: <br />❑ £DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br />❑ 5. DAILY VISUALMONITORING OF PUMPING SYSTEM• TRIENNIAL PIPING INTEGRITY <br />TEST (0.1 GPM) <br />❑ S. TRIENNIALINTEGRITY TFS(0. 1 GPM) <br />SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): <br />SAFE SUCTION SYSTEMS (NO VAL`PES :N BELOW GROUND PIPING): <br />❑ T. SEF MONITORING <br />❑ T. SELF MONITORING <br />GRAVITY FLOW. <br />GRAVITY FLOW (Cbdl aY mNA9MY): <br />❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPM) <br />❑ S. DAILY VISUAL MONITORING <br />❑ 3. 31ENNIAL.NTEGRITY TEST TO 1 GPM) <br />SECONDARILY CONTAINED PIPING <br />SECONDARILY CONTAINED PIPING <br />PRESSURIZED PIPING (CAace aP llMl apPM: <br />PRESSURIZED PIPING fClNCAalmataopryl: <br />•.0. CONTINUOUS TURBINE SUMP SENSOR` WITH AUDIBLE AND VISUAL ALARMSANO <br />10_ CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUALALARMS AND(dla .1 <br />CNN) OMI <br />❑ a. AUTO PUMP SHUTOFFWMENA LEAKOCCURS <br />❑ a AUTO PUMP SHUT OFFWNEN A LEAK OCCURS <br />❑ 0. AUTO PUMP SHUT OFF FOR LEAKS SYSTEM FAILURE AND Sys. Sm <br />❑ 0. AUTO PUMP SMuTOPF POR LEAKS. SYSTEM FAILURE AND SYSTEM OISCONNECDON <br />DISCONNECTION <br />❑ c NO AUTO RIME SMUT OFF <br />❑ c NO AUTO PUMP SHUT OFF <br />❑ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TESTI `NTN FLOW SHUT OFF OR <br />❑ 11. AUTOMATIC LEAK OETECTOR <br />RESTRICTION <br />❑12. ANNUAL INTEGRITY TEST {O.t GPNI <br />❑ 11 ANNUAL INTEGRITY TEST (0.1 GPM) <br />SUCTIONIGRAVITY SYSTEM: <br />SUCTIONIGRAVITY SYSTEM, <br />❑ 13. CONTINUOUS SUMP SENSOR• AUDIBLE AND VISUALALARMS <br />❑ t1 CONTINUOUS SUMP SENSOR- AUOIBLE.>NO VISUAL ALARMS <br />EMERGENCY GENERATORS ONLY JCA "mal SAW <br />EMERGENCY GENERATORS ONLY(Chc aY mMappy) <br />❑ 14. CONTINUOUS SUMP SENSOR`MTMOUT AUTO PUMP SMUT OFF• AUDIBLE AND <br />❑ 14. CONTINUOUS SUMP SENSOR VMTHOUT AUTO PUMP SHUT OFF • AUDIBLE AND VISUAL <br />VISUALALARMS <br />AIMS <br />❑ 15. AUTOMATIC LINE LEAK OETECTOq (30 GPI TEST) `MTI!DI)T FLOW SHUT OFF OR <br />❑ 15. AUTOMATIC LINE LEAK DIE= OR (3.0 GPM TEST) <br />RESTRICTION <br />❑ IS. ANNUAL INTEGRITY TEST (0.1 GPM) <br />❑ 16. ANNUAL INTEGRITY Tes-r a1 GPM) <br />❑ +T. DAILY VISUAL CHECK <br />❑ 17. DAILYMSUALCHECK <br />VM. DISPENSER CONTAINMENT <br />DISPENSERCONTAINMENT ❑ 1. FLOAT MECHANISM TMATSMUTS OFF SMEAR VALVE ❑ A. DAILYVISUALCNECK <br />DATE INSTAI 190 ❑ 1 CONTINUOUS DISPENSER PAN SENSOR -AUDIBLE AM) VISUALALARMS ❑ 5. TRENCHUNERIMOMTORING <br />❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SMUT OFF FOR DISPENSER -AUDIBLE AND VISUALALARMS ❑ B. NONE <br />DL OWNERIOPERATOR SIGNATURE <br />I tlfp(y N]I IN iMdmavon aroMw nNan is Nre atp atlaYau IO Ne wet al my W Wwla�s. <br />SIGNATURE OF OWNERICPERATOR DATE <br />NAME OF OMERIOPERATOR(pnml 71 t OF OWNERIOPPERATOR <br />Pmme APPIeraE <br />u owD9 <br />CUPA0ORM (4199) • FOmK.Rry SVVRCR Farm 8 <br />