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e 7-7 UNIFIED PROGRAM CONSOLIDATED FORM�"� /1 Ii 41 P' PR AI: FAC P: F UNDERGROUND STORAGE TANKS - TANK PAGE 2 ' Ig S(EOFOWNEAIOPERATOR(wi- /. .b,4 Imd N."(F%bW uc- 1 113 U'PCF (12199 revised) m e%p vA/CA c1N TITLE OF ON Pant AlgmvMDxlataluraJy) Olt EE0000646 ERATOR /A2,7-Nl7Z 1/1/1993 rtr3ors - I ' �`• ,'; '- VL PIPING CONSTRUCTION (c v9 ma mly) P GR PI'[NG ABOVE RO i 1 57EM TYPE ❑ 1. PRESSURE ®2. SUCTION ❑ S.GRAVRY ut ❑ I. PRESSURE ❑ 2. SUCITON ❑ ).GRAVITY CON3IAUCTION I. SINGLE WALL ❑3. LINED TRENCH ❑ OTHER ceo ❑ 1. SINGLE ❑ 95.UNKNOWN N d ®2.DOUBLEWALL [395 -UNKNOWN UBLEWALL 2. UBLE WALL❑ �. OTHER Y 5 { a^9 7 w1 MANUFACTURER MAALL NUFACTURER ❑ I. BARE STEEL ❑ 6. FRP COMPATIBLE M 1t METMANOL 1 '... ❑ 1. BARE STEEL ®6. PRP COMPATIBLEwIatm NETNANa. ❑ STAINLES557EEL ❑'. GALVANIZED STEEL li{ ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ PLASTICW/Q t ryryryry{ ❑ PLAWICCOMPATIBLEWi CONTENTS ❑ 95. UNKNOWN COMPATIBLE eTEELEXIBLE (HDPE] ❑ 99. OTHER • ❑ ?d ,11f ❑ {.FIBERGLASS ❑ S. FLEXIBLE (HOPE) }[Cxy�'99. OTHER Co"N''VIC, a6t ❑ S. STEEL WiCOATTNG ❑ 9. CATHODIC PROTECTION 61W ca t ❑ S. STEEL W/COATING ❑ 9. CATHODIC PROTECTION VI. PIPING LEAK DETECTION (Cbal+.n bat I ua.a:Na,mNa thin 6etub::hW m tb.,.d ABOVEGROUND PIPING t 3' UNDERGROUND PIPING ___ SINGLE WALL PIPWG a4lig f 1 S CLE WALL PIPING .s6 PRESSURIZED PIPING (C)Wk EN that appiy): + PRL96URIZED PIPING (CbtekNO that SPPIA: SHUT OFF ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST PITH AUTO PUMP S ❑ 1. ELECTRONIC LME LEAK DETECTOR 3.0 OPH TEST AM AUTO PUMP FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION-AUDRR.E r FOR LEAK. SYSTEM FA)LURE. AND SYSTEM DISCONNECTION- AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. 1) ') [3 3, MONTHLY OS GFH TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 3. ANNUAL IPTEORITY TEST (0.1 GAO ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPFp ❑ 1. DAILY V'SUAL CHECK CONVENTut IONALSUCTION SYSTEMS(CbKk20 GIWO :z CONVEN770NAL SUCTION SYSTEMSPUMPING ❑S.DNLYVISUAL MONITORING OF PIPING AND PUMPMGSYSTEM _ S. DAILY VISUAL MONITORING OF PUMPING SYSTEM TRIENNIEU. PIPING INTEGRITY TEST (0.1 GPH) ❑ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (No VALUES IN BELOW GROUTNDPIPING): SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GOOUNDNPING): ❑ 1. SELF MONITORING L7 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Cbtck all ttil IPPB): ❑ 9. BIENNIAL INTEGRITY TEST (0.1) GPM i ❑ S. DAILYVISUAL MONITORING ❑ 9. BIENNIA. INTEGRITY TEST (0.1) GPM 1 SECONDARMY CONTAINED PIPING SECONDARILY CONTAINED PIPING pESSURIZEU PIPING (Check an tial aPp1Y): PRESSURIZED PIPING (Click all Mat IPWY): IOWNTlN US TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(CM.) ALARMS AND I(3lak ove) )' ❑ 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 ANDSYt1t* ❑b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION 4N} ,!t ❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF �. a: ❑ 11. AUTOMATIC LME LEAK DETECTOR (3.0 GPM TEST) WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM ): ,SUUCCTHIN/GMvTTY SYSTEM pQ t). CONTINUOUS SUMP SENSOR* AUDIBLE AND VISUAL ALARMS SUCTION/GRAVITY SYSTEM a? ❑ 13. CONTINUOUS SUMP SENSOR i AUDIBLE AND VISUAL ALARMS + EMERGENCY GENERATORSONLY (CLad+II Nm W11)w EMERGENCY GENERATORS ONLY(Clacktn bw SM) ❑ IA CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF • 014. CONTINUOUS SUMP SENSOR WITHOl17 A UTO PUMP SHUT OFF• AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS a 15. AUTOMATIC LME LEAK DETECTOR (3.0 GPM TEST) WITH FLOW ❑ 15. AUTOMATIC LME LEAK DETECTOR 13.0 GPH TEST) WITHOUT FLOW ylt ❑ SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION fi ❑ 16. ANNUAL INTEGRITY TEST (0.1 OPH) ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) 1 ❑ 17. DAILY VISUAL CHECK ❑ IT. DAILY VISUAL CHECK VII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATEINSTALLED wI V2 CONTINUOUS DISPENSER PAN SENSOR- AUDIBLE ANDVISUAL ALARMS ❑ 5.TRENCH LINER: MONITORING 4. G501, CONTINUOUS DISPENSER PAN SENSOR WITHAUTO SHUT OFF FOR ®6. NONE �t DISPENSER I AUDIBLE AND VISUAL ALARMS UL OWANEIUOPERATOR SIGNA7TIRE IteNlyia as bMma:m PwiNe6kmm,bava maem Oatnl 3:mM6tlp. __ SIGNATURE OF OWNERIOPERATOR DATE Q311,0 3 .(,�'E6'du S(EOFOWNEAIOPERATOR(wi- /. .b,4 Imd N."(F%bW uc- 1 113 U'PCF (12199 revised) m e%p vA/CA c1N TITLE OF ON Pant AlgmvMDxlataluraJy) Olt EE0000646 ERATOR /A2,7-Nl7Z 1/1/1993