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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS- TANK PAGE 2 VI.PIPING CONSTRUCTIONcx .11tnn ra6a nr UNDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE ❑1.PRESSURE W 2.SUCTION ❑3.GRAVITY 458 ❑I.PRESSURE ❑2. SUCTION ❑3.GRAVITY lfl CONSTRUCTION ❑1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 45(l ❑1.SINGLE WALL ❑95.UNKNOWN 46z MANUFACTURER N 2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461 MANUFACTURER 463 ❑1.BARE STEEL ❑6.PEP COMPATIBLE w/I 11UN METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE W/TOMS METHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑I1R1muav0 ❑2. STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑99.Other ❑3. PLASTIC COMPATIBLE W/CONTENTS ❑S.FLEXIBLE(HDPE) ❑99. OTHER ja 4.FIBERGLASS ❑&FLEXIBLE(HDPE) ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 454 ❑5. STEEL W/COATING ❑95.UNKNOWN 465 VIL PIPING LEAK DETECTION oarll.httnn I A oe o(ahemmi shall be sobm1"edtotlalrc1xjn ) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Chock all Poat.W y. PRESSURIZED PIPING(cheat all mataPdy): ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WSDI AUTO PUMP SHUT (]1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WlTft AUTO PUMP OFF FOR LEAR,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ❑2.MONTHLY 02 GPHTEST ❑2. MONTHLY 02 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(Clack eR t6m appy) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPINGy GRAVITY FLOW 07. SELFMONITORING ❑9.BIBNNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Clark all than apply} ❑&DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING it s au thatepply} PRESSURIZED PIPING nAer&ell that appy): 10. CONTINUOUS TURBINE SUMP SENSOR WIDI AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(CTeek aro) ALARMS AND(Check one) ❑a. 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 SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION W. NO AUTO PUMP SHUTOFF Oc NO AUTO PUMP SHUT OFF ❑11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) FLOW SHUT 0 11 AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ❑12. ANNUAL INTEGRITY TEST 10.1 GPID ❑12. ANNUAL INTEGRITY TEST(O.1 GPH) SUCTION/GkAVITY SYSTEM SUCTION/GRAVITY SYSTEM Of 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(CU&dl Rut appy) EMERGENCY GENERATORS ONLY(C'heck all thn apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUf AUTO PUMP SHUTOFF ❑14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF a AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW 0 15. AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑17. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VIIL DISPENSERCONTAINl1ENT DISPENSER CONTAINMENT ❑1.FLOATMECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTALLED 458 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONrroI NG ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 6.NONE 'NOT Q FMK 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I amriy thaw e on pov" ' hue aadarolbe yk.kdpa. SIGNATU OPP TORDATE - Oro 0 NAM OF OWNER/OP (print) SII TITLE OF OWNS PERATOR 472 Mr• b I<hun Dir v of MuintenanCG Pm mit Nombar(Fm osenaly) 473 Pamif Appovrd(Far laraluu.Wy) 474 Permit l!aphalioo MY(Fabal vs only) 475 UPCF(12199 revised) 12 Formerly SWRCB Form B