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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION(Checkaftthafapply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE 2. SUCTION ❑ 3. GRAVITY 111. PRESSURE 2. SUCTION ❑ 3. GRAVITY CTION CONSTRUT SINGLE WALL ❑ 3. LINED TRENCH ❑99. OTHER ❑ 1. SINGLE WALL ' ❑95. UNKNOWN MANUFACTURER ❑ 2, DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER 1.BARE STEEL ❑ e. FRP COMPATIBLE WI 100%METHANOL ❑ 1. BARE STEEL ❑ B. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ ]. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ ]. GALVANIZED STEEL CORROSION 11 PROTECTION 3. PLASTIC COMPATIBLE NTH CONTENTS ❑ PLASTIC 85. UNKNOWN ❑ 3. PLASTIC COMPATIBLE NTH CONTENTS 11e. FLEXIBLE(HDPE) ❑99.OTHER ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE(HDPE) 09. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WICOATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑95. UNKNOWN VIL PIPING LEAK DETECTION{Check aft that appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check aft that appy): PRESSURIZED PIPING(Check aft that apply): ❑ 1 ELECTRONIC LINE LEAK OETECTOR 3.0 GPM TEST NTH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 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 02 GPM TEST ❑ 2. MONTHLY D2GPH TEST ❑ 3. ANNUAL INTEGRITY TEST(0,1 GPM) ❑ 3. ANNUAL INTEGRITY TEST IDI GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELFMONITORING ❑ ]. SELFMONITORING GRAVITY FLOW GRAVITY FLOW(Chackall that apply): ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND Ued one (Coed one) ( ) ❑ e. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ e. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b. AUTO PUMP SHUTOFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ a NO AUTO PUMP SHUT OFF ❑ C. NOAUTOPUMPSHUTOFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR SD GPM TEST)NTH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITYTEST(0.1GPH) ❑ 12. ANNUAL INTEGRITY TEST(0 1 GPM) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM. ❑ 13. CONTINUOUS SUMP SENSOR AUDIBIE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR,AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check as ON appy) ❑ 14. CONTINUOUS SUMP SENSOR`MTHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR CID GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 1B. ANNUAL INTEGRITY TEST(9.1 GPH) ❑ 17. DAILYVISUAL CHECK ❑ t]. GAILY VISUAL CHECK VUL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER I MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR NTH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS NONE IX.OWNER)OPERATOR SIGNATURE I party Net Ne inkrmalicn provided herein Is"a and accurate to Ne best of my knovded9e. SIGNATURE OF OWNERIOPERATOR DATE NAME OF OWNEWOPERATOR(point) TITLE OF OWNERIOPERATOR - Parent Number(Forlpcal use onW Paonit Approved(Irorkcal use oW PanMt Exptratlpn Data(Forloca/wa oMy) CUPAFORM(4/99) 0 • Formerly SWRCB Form B