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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION Checkall Wats 1- Page 1 of l <br /> UNDERGROUND PIPING I ABOVEGROUND PIPING <br /> SYSTEM TYPE 1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 458 0 1.PRESSURE ❑2. SUCTION D 3.GRAVITY 459 <br /> CONSTRUCDON ���0y 1.SINGLE WALL 0 3.LINED TRENCH [199.OTHER 460 0.1.SINGLE WALL 0 95.UNKNOWN 462 <br /> MANIIFACfURER Ib2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER <br /> MANUIF`ACTUAEA <br /> .0 <br /> S 461 MANUFACTURER 463 <br /> D 1.BARE STEEL [16.FRP COMPATIBLE wAGW1. METHANOL D 1.BARE STEEL D 6.FRP COMPATIBLE W/1 W%METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 Unknown ❑2. STAINLESS STEEL Cl 7.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPATIBLE W/CONTENTS 0 99. Otho ❑3. PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEXIBLE(HDPE) 0 99. OTHER <br /> X4.FIBERGLASS ❑8.FLEXIBLE(HDPE) 0 4. FIBERGLASS 1 0 9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING W CATHODIC PROTECTION 464 0 5. STEEL W/COATING [195.UNKNOWN 465 <br /> VIL PIPING LEAK DETECTION(Ch klll"'alhxcd tion ufWemowarm mxhell besubminedro Ue locala•enc. <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(C kali 0wteppiy): PRESSURIZED PIPING(Gawk all that apply): <br /> �1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> D 2.MONTHLY 0.2 GPH TEST 02. MONTHLY 0.2 GPH TEST <br /> Ip(3.ANNUAL INTEGRITY TEST(O.IGPH) D 3.ANNUAL INTEGRITY TEST(O.IGPH) <br /> D 4. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chcckall Watapply) <br /> 0 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING D S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELF MONITORING <br /> 0 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check Jl that ap aJI <br /> 0 8. DAILY VISUAL MONITORING <br /> [19. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Checkell that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSORS AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> AkARMS AND(Chock one) ALARMS AND(Check we) <br /> AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> . AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> Oc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> ❑ <br /> 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 0 I1 AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) [112. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS C 13. CONTINUOUS SUMP SENSOR,AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all dot apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> 0 14. CONTINUOUS SUMP SENSOR WITHOITT AUTO PUMP SHUTOFF• [114. CONTINUOUS SUMP SENSOR WITH011T AUTO PUMP SHUT OFF' <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> [116.ANNUAL INTEGRITY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 0 17. DAILY VISUAL CHECK 0:7. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 0 I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS D 5.TRENCH LINER/MONITORING <br /> NIR N 19 X3 CONTINUOUS+AUDIBLEE AND VISUAL ALARMS <br /> AUTO SHUT OFF FOR <br /> ❑6.NONE 469 <br /> D PEN ES RA <br /> IX.OWNER/OPERATOR SIGNATURE <br /> Icrrofy slut themfaaacan c.' we as We bat of kmwledge. <br /> ,SIGNATURE 0 OP DATE 490 <br /> Y 1 Q`T-- <br /> M FO' t) -C r2 . 471 TITLE OF OWNER/OPO471 <br /> Pem�it Numha(Frl ase rally) 473 ! Pemdt Approved(For local uae only) 474 vfaPatratIEExpiUation Date(For loco)use only) 475 <br /> UPCF(12/99 revised) 12 Formerly SWRCB Form B <br />