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UNMED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> VL PIPING CONSTRUCTION ceeat.nmm n9e °f <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 0 L PRESSURE fa 2.SUCTION ❑3.GRAVTLY bit Cl 1.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 <br /> CONRTRuenoal D 1.SINGLE WALL D 3.LINED TRENCH 0 99.OTHER 450 ❑1.SINGLE WALL ❑95.UNKNOWN 867 <br /> MANUFACTURER 10 2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 13 W.OTHER <br /> MANUFACTURER 461 MANUFACTURER 4lJ <br /> ❑1.BARE STEEL 0 6.FRP COMPATIBLE w1100u METHANOL 0 1.RARE STEEL 0 6.FRP COMPATIBLE W/l0ow METHANq <br /> 0 2.STAINLESS STEEL D 7.GALVANIZED STEEL 0 UnkOokm D 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> [13.PLASTIC COMPATIBLE W/CONTENTS 0%. Other 0 3. PLASTIC COMPATIBLE W/CONTENTS 0 R FLEXIBLE(HDPE) ❑%. OTHER <br /> M 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) [14. FIBERGLASS 0 9.CATHODIC PROTECTION <br /> ❑ <br /> S.STEEL W/COATING [19.CATHODIC PROTECTION 854 0 5. STEEL W/COATING 0 95.UNKNOWN e(S <br /> VIL PIPING LEAK DETECTION c1a.&O w, 1 (A wank:m„i ,Mu 6ewmmM,ebtke teal <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 4m <br /> PRESSURIZED PIPING(C6ed an flat apply): PRESSURIZED PIPING(tact)a0 Ont appy): <br /> ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST AUTO PUMP SHUT 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESTyV)j}j AUTO PUMP <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> 0 2.MONTHLY 0.2 GPH TEST 0 2. MONTHLY 0.2 OPH TEST <br /> 0 3.ANNUAL INTEGRITY TEST(0.1 GPH) 0 3.ANNUAL INTEGRITY TEST(0.LOPE) <br /> D4. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMSp( atUlat apply) <br /> ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPHI <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPINGI: 06. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELF MONITORING <br /> 0 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(CTed a0 that appy) <br /> 0 8.DAILY VISUAL MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 OPE) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(m&.0 Mat appy): PRESSURIZED PIPING(C led tll film apply) <br /> 10.CONTINUOUS TURBINE SUMP SENSOR=AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSORAUDIBLE AND VISUAL <br /> ALARMS AND(Cream)) ALARMS AND(CMdak) <br /> ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑e AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> 0c. NO AUTO PUMP SHUT OFF 0c NO AUTO PUMP SHUT OFF <br /> D 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 0 11. AUTOMATIC LEAKDETECTOR <br /> OFF OR RESTRICTION <br /> 0 12.ANNUAL INTEGRITY TEST(0.1 OFF) 0 12.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVTIY SYSTEM <br /> 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(CT k all"apply) EMERGENCY GENERATORS ONLY(CTed all Mm apply) <br /> 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' ❑14. CONTINUOUS SUMP SENSOR WTIHOUT AUTO PUMP SHUT OFF' <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> D 15. AUTOMATIC LINE LEAKDETECTOR(3.0 GPH TEST)WITH FLOW 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> [116.ANNUAL INTEGRITY TEST(0.1 GPHI 0 16.ANNUAL INTEGRITY TEST(0.l GPH) <br /> D 17. DAILY VISUAL CHECK D 17. DAILY VISUAL CHECK <br /> VIIL DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 01.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04.DAILY VISUAL CHECK <br /> DATE INSTALLED 469 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 5.TRENCH LINER/MONITORING <br /> D 3.CONTINUOUS DISPENSER PAN SENSOR RTTII AUTO SHUT OFF FOR <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS )Q 6.NONE 469 <br /> OWNERIOPERATOR SIGNATURE <br /> lamifYtmtt6e i,Mtmn- view eaM arc roe be, rkvowledg. <br /> SIGNATURE O E O TOR DATE / (� O Z aro <br /> NAME OF OPRA prinp 871 TITLE OF OWNER/OPERATOR 473 <br /> I J<hun Dimictor of Maintenance <br /> Pemil Number(Fa l6m oNY) 47,v Permit Appmved(For taut me umy) 474 Permit Eapwta Nk(F.bat ue way) 475 <br /> UPCF(12199 revised) 12 Formerly SWRCB Form B <br />