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a � � UMFIEED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 2 VL PIPING CONSTRUCTION cha,n fnm F.gt or UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 911.PRESSURE ❑2.SUCTION ❑3.GRAVITY Mg ❑1.PRESSURE ❑I SUCTION ❑3.GRAVITY 459 CONSTRUCTION [11.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 16o I7 1.SINGLE WALL MANUFACTURER 92.DOUBLE WALL [195.UNKNOWN El99 2.DOUBLE WALL 0 .UNKNOWN 462 W ^- ❑W.OTHER MANUFACTURER Dwells COYDNT a61 MANUFACTURER 463 ❑1.BARE STEEL ❑6.FRP COMPATIBLE w/l0 METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE WllO METHANOL. ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑URkR ❑2. STAINLESS STEEL 117.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑99. Orbe ❑3. PLASTIC COMPATBLE W/CONTENTS ❑R.FLEXIBLEHDPE ®4.FIBERGLASS 1:18.FLEXIBLE(HDPE) ❑4.FIBERGLASS FLEXIBLE( ) 99. OTHER ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING [19 CATHODIC PROTECTION 464 ❑S. STEEL W/COATING ❑95.UNKNOWN 465 VIL PIPING LEAK DETECTION ce kat.f. f A monbamml an.n Msabmbrcdfo7M loot UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING *7 PRESSURIZED PIPING(Chap an ft'wly): PRESSURIZED PIPING(Gnat all Poa-MY), ❑L ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO 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 ❑2 MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑3.ANNUAL INTEGRITY TEST(0.1 OPEL) 114. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(CIM&A f1w gVly) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING El INTEGRITY TEST(0.1 GPH) 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING} ❑6. TRIENNIA,INTEGRITY TEST(0.1 GPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPINGr GRAVITY FLOW 07. SELF MONITORING ❑9.BIENNIAL INTEGRITY TEST ED.1 GPH) GRAVITY FLOW(Cleaan 1n apply): ❑R DAILY VISUALMONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Chea Ml rom vpFly): PRESSURIZED PIPING(Chea vR row m,lrt 10. CONTINUOUS TURBINE SUMP SENSOR WIIII AUDIBLE AND VISUAL 10. CONTINMUS TURBINE SUMP SENSOR ALARMSAND(Chaou) ALARMS AND(CSM om) Y'CDIAUDIBLE AND VISUAL ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHOT OFF WHEN A LEAK OCCURS ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION 01c. NO AUTO PUMP SHUT OFF (]c NO AUTO PUMP SHUT OFF ❑11. AUTOMATIC LINE LEAK DETECTOR(3.11 GPH TEST)MM FLOW SHUT OFF OR RESTRICTION ❑11. AUTOMATIC LEAKDETECTOR 12. ANNUAL INTEGRO Y TEST(0.1 GPH) O 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCIONIGRAVIIY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑D. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(ChM AI ro vply) EMERGENCY GENERATORS ONLY(Cha et Ew apply) ❑14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• ❑14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)W17HOVf FLOW (3. SHUT OFF OR RESTRICTION SIS.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑17.DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DARY VISUAL CHECK DATE INSTALLED 469 J02.CONTINUOUS DISPENSER PAN SENSOR+AUDBLE AND VISUAL ALARMS 05.TRENCH LINER MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR W AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS 6.NONE 469 IX.OWNER/OPERATORsIGNATURE larnfyro hm bofofmyhoowbdg. SIG OFOPERATO DATE ^/ }- O dm FO RATOR f) 471 TIME OF OWNER/OPERATOR 4n Mr. �►iun I DNreotor o{ Maintp-rlavice Famif Numbs Fm bol ua mlY) 473 Fe t AppovW(Fm local m mly) 474 Pefmif Expkmhm Darc(Fm local me.[y) 475 UPCF(12/99 revised) 12 Formerly S"CB Form B