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UNIFIED PROGRAM CONSOLIDATED FOR ® TANK TA0508144 PR#: PR0231667 UNDERGROUND STORAGE TANKS -T NK PAGE 2 p 11,A1OFAC#: FA0002121 VI.PIPING CONSTRUCTION(Ch attoaappy) V� PW5ors �/ UNDERGROUND PIPING ABOVEGROUND PIPING O3 SYSTEM TYPE 1.PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY 458 ❑ 1.PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY 459 CONSTRUCTION ,❑11.SINGLE WALL [:]3.LINED TRENCH El ".OTHER 460 [11.SINGLE WALL El 95.UNKNOWN 462 LJ 2.DOUBLE WALL 095.UNKNOWN ❑ 2.DOUBLE WALL ❑ 99.OTHER MANUFACTURER m1 MANUFACTURER 463 ❑ I.BARE STEEL ❑6.FRP COMPATIBLE w/I W%METHANOL ❑ 1.BARE STEEL ❑6.FRP COMPATIBLE V 100X METHANOL ❑2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN Q 4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER ❑ 4.FIBERGLASS ❑ S.FLEXIBLE(HDPE) ❑ 99.OTHER ❑ 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 461 ❑ 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 465 VR.PIPING LEAK DETECTION(OTxk aR llutapply)(A Aemption ofthcnotte rmgprop/xnstoll hesobmindroNelotel ae y.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 40 PRESSURIZED PIPING(Check ell that apply): PRESSURIZED PIPING(Check all that apply): Q 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH TEST ❑ 2.MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) © 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑ 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING ❑ 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) ❑ 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑ 7.SELF MONITORING ❑ ].SELF MONITORING GRAVITY FLOW ❑ 9.BIENNIA.INTEGRITY TEST(0.1)GPH GRAVITY FLOW(Check NI that apply): ❑ S.DAILY VISUAL MONITORING ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMSAND(O'M .) ALARMSAND(C7eelt.) 0 a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [Tb.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b.OO PUM7PON�OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c.NO AUTO PUMP SHUT OFF ❑ c.NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR ❑ 11 AUTOMATIC LEAK DETECTOR TRICTION 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(C3eck au Out apply) EMERGENCY GENERATORS ONLY(Chale all Nat apply) ❑k'14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF a ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF e AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS .-/15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHO[JT FLOW E] 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW E SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION U] 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT LJt'FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4.DAILY VISUAL CHECK DATEINSTALL�LED 468 [vr2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALAR MS ❑ 5.TRENCH LINER/MONITORING 1/ '��jj ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑ 6.NONE DISPENSER+AUDIBLE AND VISUAL ALARMS 469 IX.OWNER/OPERATOR SIGNATURE I octi Nat the intonation provided he is vuc and ao;uate to the nnl otmy koo l ;c SIGNAT3)RE OF OWNER/OPERATOR t 470 NAME OF OWNEROPER.4T0 ring 471 TLv /V 471 Ptmlt Nmrber(Fmlamltecoety) 1473 Pmrvt Appmvd(Fatlomlmcady) 474 Permit Expiration NW(F9rlomt ascady) 475 PT0002113 EE0000646 6/30/2004 UPCF(12/99 revised)