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r�4 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS -TANK PAGE 2 TANKS VL PIPING CONSTRUCTION CTed.ut6at nue .r UNDERGROUND PIPING ABOVEGROUND PIPING SYSTAITYPE X 1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 458 O L PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 CONSTRUCTION ❑L SINGLE WALL ❑3.LINED TRENCH []99.OTHER 4b0 ❑1.SINGLE WALL95.UNKNOWN 463 MANUFACTURER ❑2.DOUBLE WALL [195.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461 MANUFACTURER as3 ❑1.BARE STEEL 06.ARP COMPATIBLE w/Iar,6 METHANOL ❑1.BARE STEEL 116.FRP COMPA71BLE W/JO METHANOL ❑2.STAINLESS STEEL 117 GALVANIZED STEEL ❑UnkD . ❑2. STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑99. Other ❑3. PLASTIC COMPATIBLE W/CONTEN S ❑R.FLEXIBLE(HDPE) ❑99. OTHER 10 4.FIBERGLASS ❑&FLEXIBLE(HDPE) ❑4.FIBERGLASS ❑9.CATHODIC PROTECTION ❑S STEEL W/COATING ❑9.CATHODIC PROTECTION 46C ❑5. STEEL WCOATING ❑95.UNKNOWN qA5 VIL PIPING LEAK DETECTION tied vpthat 1) A .�otthcmooi amn ee a.hmilkdfoth lamla en . UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 4Rf SINGLE WALL PIPING a67 PRESSURIZED PIPING(C .Il®at"y2 PRESSURIZED PIPING(Che&all Mmt apply): ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESTS AUTOPUMPSHUT 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITti AU70 PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH TEST 13 2. MONINLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(O.I GPH) O 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(CMd ae 1Wt appy) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) ❑5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPINGr. 116. TRIENNIAL INTEGRITY TEST(0.1 GPH) [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7. SELF MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(CTed all that wty): ❑&DAILY VISUAL MONITORING [19. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(eTed au that apply): PRESSURIZED PIPING(teed all that appy). 10. CONTINUOUS TURBINE SUMP SENSOR]YIDT AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WI AUDIBLE AND VISUAL ALARMS AND(Chedo.e) ALARMS AND(Ue&t ) D a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑K AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION �c. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF ❑11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT I L AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION j1 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(LTed.11 that apply) EMERGENCY GENERATORS ONLY(Cha.11 Mut apply) ❑14.CONTINUOUS SUMP SENSOR WITTIG AUTO PUMP SHUT OFF e ❑14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW 0 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) [117-DAILY VISUAL CHECK ❑17.DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑L FLOAT MECHANISM THAT STILTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTALLED Mll 102.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [15.TRENCH LINER/MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR W AUTO SHUT OFF FOR O 6.NONE 469 DISPENSER+AUDIBLE VISUAL ALARMS .OWNER/OPERATOR SIGNATURE I aetiHroatl , Mon l.a Iah.ee.M mt& rmytoowkd9, SIG RE O TOR DATE Oro NAME OF OWNER/O OR t) 47l TITLE OFOWNER/OPERATOR 4n Nr vki DireCtar of MnivtTenattee Pen.il N..M(F Iws C.IY) 4>3 P tl Ap vakl(FM I. latae WY) 474 Pcm,it FA m mDafe(I'm lwalu 0*) 473 UPCF(12/99 revised) 12 Formerly SWRCB Form B