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b-NIFIED PROGRAM CONSOLIDATED FOR I rL, KV UNDERGROUND STORAGE TANKS - TANK PAGE 2 VL PIPING CONSTRUCTION (CMck aYfhM appy) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 0 1 PRESSURE X2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 0 1. SINGLE WALL ❑ 3. UNEDTRENCH ❑ 99. OTHER ❑ 1. SINGLE WALL ❑ 95. UNKNOWN CONSTRUCTION MANUFACTURER . DOUBLE WALL ❑ 95. UNKNOWN ❑ 2. DOUBLE WALL ❑ 99. OTHER MANUFACTURER MANUFACTURER ❑ 1. BARE STEEL ❑ S. FRPCOMPATIBLEW/WO%METHANOL ❑ 1. BARE STEEL ❑ 6. FRPCOMPATIBLEW/100%METHANOL MATERIALSAND ❑ 2, STAINLESSSTEEL ❑ T. GALVANIMDSTEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ a. FLEXIBLE (HOPE) - 1199, OTHER rFIBERGLASS 11S. FLEXIBLE (NOPE) ❑ 99. OTHER ❑ 4. FIBERGLASS 119. CATHODIC PROTECTION ❑ 5. STEEL Wl COATING ❑ B. CATHODIC PROTECTION ❑ 5. STEELWI COATING ❑ 95. UNKNOWN VIL PIPING LEA( DETECTION (Cheat Mrhat appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLEWALLPIPING PRESSURIZED PIPING (Chaah a9 fhaf apply): PRESSURIZED PIPING (Crock a6 that apply): ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST W TH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3A 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 ALARMS ❑ 2. MONTHLY D2 GPM TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (C all that apply), ❑ PUMPING ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM TRIENNIAL PIPING INTEGRITY 5. DAILY VISUAL MONITORING OF PIPING AND SYSTEM TEST (0.1 GPM) ❑ 6. TRIENNIAL INTEGRITY TEST 10.1 GPM) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING)'. ❑ T. SELF MONITORING ❑ 7. SELFMONITORING GRAVITY FLOW: GRAVITY FLOW (Chackall I/rot appy)' ❑ 9. BIENNIAL INTEGRITY TEST (0 1 GPM) ❑ 9. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Chack 46 thatapply): PRESSURIZED PIPING (Check an that appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND ONNTINUO 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(UroG one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM 11b. AUTO PUMP SHUT OFF FOR LEAK$, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SMUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST (C.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) U TION/GRAVITYSYSTEM: SUCTION/GRAVITY SYSTEM'. 13, CONTINUOUS SUMP SENSOR• AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (CM aha that apply) EMERGENCY GENERATORS ONLY (Cluck an that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WTHOUT AUTO PUMP SHUT OFF+ AUDIBLE AND VISUAL VISUALAIARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (60 GPM TEST) WTHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR (3.0 GPM TEST) RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST (0 1 GPM) ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPM) C317. DAILYWSUAL CHECK ❑ 17. OAILY VISUAL CHECK VRI. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1 FLOAT MECHANISM THAT SMUTS OFF SHEAR VALVE ❑ 4. DAILYVISUALCHECK DATEINSTALLEO ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+ AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER IMONITORING 03. CONTINUOUS DISPENSER PAN SENSOR WITHAUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL AI -ARMS XNONE CL OVMER/OPERATOR SIGNATURE I fy that Gro ah i awn pmN harem is bee and a=nle W Gro bat of my kno wchp. SIGNATURE OF OWAMERIOPERATOR WTE NAME OF OWNERAJPERATOR (phl0 TITLE OF OMMELOPERATOR CUPAFORM (4/99) -J Formerly SWRCS Form B