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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check aB Hlatapply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE ❑ 2. SUCTION ❑ 1 GRAVITY ❑ 1. PRESSURE ❑ 2.SUCTION ❑ 3. GRAVITY CONSTRUCTIOW ❑ 1. SINGLE WALL ❑ 3. UNEDTRENCH ❑99. OTHER ❑ 1. SINGLE WALL 1195. UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL ❑95. UNKNOM ❑ 2. DOUBLE WALL 1199. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ S. FRP COMPATIBLE W/WO%METHANOL ❑ 1. BARESTEEL ❑ S. FRP COMPATIBLE WI 100%METHANOL MATERMLSAND ❑ 2. STAINLESS STEEL ❑ T.GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ ].GALVANIZED STEEL CORROSION PROTECTION ❑ 3. FUSTIC COMPATIBLE PATH CONTENTS [JOS. UNKNONM 13U 3. PLASTIC ICOMPATIBLE WITH CONTENTS 11 B. FLEXIBLE(HDPE) 089.OTHER ❑ 4. FIBERGLASS ❑ S. FLEXIBLE(HDPE) ❑9e OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WICOATING 1195. UNKNOYM VIL PIPING LEAK DETECTION(Check a9 that Appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALLPIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check 0)het apPM: ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION i AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION;AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2.MONTHLY 02GPHTEBT ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 1 ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check of Nat appyt: ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ &TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN SELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELFMONITORING ❑ T. SELFMONITORING GRAVITY FLOW: GRAVITY FLOW(CMKka9 Maf appy): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ e. DAILY VISUAL MONITORING - ❑ S. BIENNIALINTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check a9 that appy): PRESSURIZED PIPING(Check ek Mat apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AMD(TAea one) (Chea Ana) ❑ e.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 ❑ b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ 1 NO AUTO PUMP SHUT OFF ❑ a NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC LINE 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) SUCTIONIGRAVITY SYSTEM: SUCTION/GRAVITYSYSTEM: ❑ 13.CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR S AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check 0 Mat appy) EMERGENCY GENERATORS ONLY(CMKk a9 met apply) ❑ 14.CONTINUOUS SUMP SENSOR YWTHOUT AUTO PUMP SHUT OFF•AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15.AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)WATHOUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 19.ANNUAL INTEGRITY TEST(0.1GPH) ❑ 18. ANNUAINTEGRITY TEST(0+1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 1]. DAILY VL'SUALCHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR a AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH UNER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR`MTH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ e. NONE OL OWNER/OPERATOR SIGNATURE I uNry Net Ne Information pmvMetl Heroin N hue an0 aCunle to Na bat al my krwWe4pa. SIGNATURE OF OWTIERIOPERATOR DATE NAME OF OVMEWOPERATOR(p4iM) TIRE OF OWNENGPERATOR Penni)Number(Forlocal use only) Panni)Appmvaa(Fcrbcsl uaa anal Permd ExpvaOon Dale(Forhocal uae oNy) CUPAFORM(4/99) Formerly SWRCR Form 8