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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VL PIPING CONSTRUCTION m .utwmoPage of UNDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE ❑L PRESSURE ❑Z SUCTION X 3.GRAVITY 458 ❑1.PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 CONSTRUCTION ❑1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTIffR 460 ❑1.SINGLE WALL E:195.UNKNOWN 463 N1 MANUFACTURER W 2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑w.OTHER MANUFACTURER 461 MANUFACTURER 461 ❑L BARE STEEL ❑6.FRP COMPATIBLE w/1EOR METHANOL ❑1.BARE STEEL [16.FRP COMPATIBLE W/IUUX METHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑Unita.. ❑2. STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑99.Other [13. PLASTIC COMPATIBLE W/CONTENTS [18.FLEXIBLE(HDPE) ❑W. OTHER V 4.FIBERGLASS ❑8.FLEXIBLE(HDPE) [14. FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 465 [IS. STEEL W/COATING ❑95.UNKNOWN 465 VIL PIPING LEAK DETECTION Cme&.utw. >(A mofinemmnono a6aR ee ao6mimdtotEe lool UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(On&all mat appy) PRESSURIZED PIPING(CM&all Mt apply): ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WIT} AUTO POMP 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 ❑2. MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.IGPH) ❑3.ANNUAL INTEGRITY TEST(0.IGPH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(M&.11flan apply) ❑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 PIPING): GRAVITY FLOW ❑7. SELF MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Cme&an tw applYl: ❑8. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(tae&.0 roan apply? PRESSURIZED PIPING(meek.0 thanapeH7 10. CONTINUOUS TURBINE SUMP SENSOR WyTH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WWD}II AUDIBLE AND VISUAL ALARMS AND((.7r&ua) ALARMS AND(C6e&) ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑It.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 (]c NO AUTO PUMP SHUT OFF ❑11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)W FLOW SHUT 0 1I AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ❑12.ANNUAL INTEGRITY TEST(0.1 GPH) [112. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM pi13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS F-1 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Cls&all mat.pey) EMERGENCY GENERATORS ONLY(CSaet.0 man apply) [114.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF• ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW p 15.AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑17.DAILY VISUAL CHECK ❑17.DAILY VISUAL CHECK VIIL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTALLED AN ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 60 6.NONE No d I S PS D Sln 469 DISPENSER+AUDIBLE AND VISUAL ALARMS >X.OWNER/OPERATOR SIGNATURE « 1 aify that Hw is vM. eaN ac yknewleAge. SIGNATURE TOR DATE 470 NAME OF OWNER/OP (print) 471 TITLE FO R/IFERATOR 4n my. I�hun D�re�ar MaiPfrenencs Pamir Number(por 1 aHyl 473 Pmnit Ap aal(Forlool,eemly) 474 Pwmit EaPintim Date(Pw bean use only) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form B