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UNIFIED PROGRAM CONSOLIDATED FO0 4� TANKS `' UNDERGROUND STORAGE TANKS - TANK PAGE 2 -- PRP d VI.PIPING CONSTRUCTION(CAaPp r not Wpy) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1 PRESSURE ❑ 2. SUCTION ❑ 0. GRAVITY ue ❑ I PRESSURE ❑ 3 SUCTION ❑ 0 GRAVITY CONSTRUCTIOW ❑ 1. SINGLE WALL C10. LINED TRENCH ❑99. OTHER 460 ❑ L SINGLE WALL ❑96. UNKNOWN 462 MANUFACTURER 2. DOUBLE WALL Cl95. UNKNOWN I❑ 2. DOUBLE WALL ❑N. OTHER MANUFACTURER 461 MANUFACTURER 460 I❑ 1.BARE STEEL IZ4 S. FRP COMPATIBLEOL ❑ t. BARE STEEL ❑ S. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ W/100%METHAN 2, STAINLESS STEEL ❑ 7. GALVANIZED 3iFF1 ❑ 2. STAINLESS STEEL C17. GALVANIZED STEEL PROTECTION CORROSION ❑ 0 PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 7. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE(HOPE) ❑99. OTHER ' ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE(NOPE) ❑99. OTHER ❑ /. FIBERGLASS ❑ 9. CATNOOK;PROTECTION ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 181 ❑ S. STEEL W1 COATING ❑96. UNKNOWN 465 VII.PIPING LEAK DETECTION(GecYY6AN ppy) - UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(CA4a W TW appy): PRESSURIZED PIPING(Gadr Y"apply): ❑ I. ELECTRONIC UNE LEAK DETECTOR 0.0 GPH TEST WITH AUTO RUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR J.0 GPM TEST WITH AUTO Pump SHUT OFF FOR LEAK, LEAK SYSTEM FAILURE AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS AlARM9 ❑ 7 MONTHLY 02 GPM TEST ❑ 2. MONTHLY 02 GPM TEST ❑ 0, ANNUAL INTEGRITY TEST(0.1 GPM) ❑ S. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Gear Y tlmf app/y): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPINGy ❑ 7. SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOWGRAVITY FLOW(Chad a1 nM appy): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ S. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(o.I GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Gad so that appy): PRESSURIZED PIPING(('Aad al Tel apply)' 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL AIARALS AND(Me (Cued mel �) a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PNMp SHUT OFF WHEN A LEAK OCCURS p. AUTO PUMP SMUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM (DISCONNECTION ❑ p. AUTO PIMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c NO AUTO P)mp SHUT OFF 11, AUTOMATIC LINE LEAH DETECTOR(S.0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION C11 t AUTOMATIC LEAK DETECTOR❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) N/A ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) �TTICWGRAVITY SYSTEM: I]. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS SUCTIOWGRAVITY SYSTEM: C1 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(CAecY MTN apply) i'❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND EMERGENCY GENERATORS ONLY(Gaet s9 nal appy) VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PIMP SHUT OFF•AUDIBLE AND VISUAL ❑ 15. AUTOMATIC LINE LEAK DETECTOR(0.0 GPM TEST)W 40 FLOW SHUT OFF OR ALARMS RESTRICTION ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST) ❑ 16. ANNUAL INTEGRITY TEST 10.1 GPM) ❑ , ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPM) 17DAILY VISUAL CHECK ❑ ❑ DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ C DAILY VISUAL CHECK DATE INSTALLED 456 IN 2. CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER I MONITORING - ❑ 0. CONTINUOUS OISPENSER PAN SENSORT�AUTO SMUT OFF FOR DISPENSER•AUO18LE AND VISUAL ALARMS ❑ S. NONE 469 IX OWNERNOPERATOR SIGNATURE I cMRy Ihal Ina inrmnillm m ocl perarn a PUa srq mole to 9M papa d m IV gs. 51GNATU OF OwNE PERAiOR DATE 470 NaME OF OWNEPoOPE T p UI TITLE OFO E PERATOR 472 Tim Juif (pooI Agent for Owner aural N.'a.frm tical Vpa wlry) 470 Parana APPrpM tla bfJl pss Pnry) 174 Pemn E.plrii Co.a(Fw bolo»o'VYI 475 UPCF(1/99) Falmedy SWRCB Form B