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UNIFIED PROGRAM CONSOLIDATED FORM <br /> =TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> Page a <br /> VI.PIPING CONSTRUCTION jOwNi a'I,mal appy) <br /> UNDERGROUND P:PING ABOVEGROUND PIPING <br /> ',.SYSTEM ME 10 I. PRESSURE o-z. SUCTION 0 3. GRAVITY aS8 I 0 1. PRESSURE 0 2. SUCTION 0 3, GRAVITY 1591 <br /> �U�l <br /> ❑ 1. SINGLE WALL 03. LIMED TRENCH 0M. OTHER 460 01. SWGLEWA 095. UNmowN1CONSTRULTIOMAI.LFACTUREDOUBLEWALL ❑95. UNKNONM ❑ 2. DOUSLEWALL ❑99. OTHER <br /> MANUFACTURER 4B1 MANUFACTURER 4631 <br /> 10 A.BANE STEEL 06. FRPCOMPAINSLEW7100%METHANOL 0 1. BARE STEEL ❑ 6 FRP COMPATIBLE WT 100%METHANOL <br /> MAMRVU 5 AND 10 2 STAINLESS STEEL 0 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑7. GALVANIZED STEEL <br /> .CORROSK)N <br /> PROTECTION 10 3. PLASTIC COMPATIBLE WITH CONTENTS _ ❑95. UNIWOWN 0 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ S. FLEXIBLE(HOPE) 099. OTHER <br /> 'Cl 4. FIBERGLASS 0 B.FLEABLE(HDPE) 099. OTHER 0 k FIBERGLASS 0 9, CATHODIC PROTECTION <br /> I❑ S. STEEL VR COATING 0 S. CATHODIC PROTECTION AS,, I❑ 5. STEELWICOATING 095. UNKNOWN 465: <br /> VII.PIPING LEAK DETECTION(CheckaPNat appy)(AdescAptim ottlle mbe'.hnry pr�gam sf:an De svDmaxNm lli<kaal agenpy) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 4611 SINGLE WALL PIPING 467; <br /> PRESSURIZED PIPING(Chep:as Nat appy): i PRESSURIZED PIPING(Check 80 Nat apply): <br /> ❑ 1. ELECTRONIC LINE LEAK DETECTOR 30 GPM TEST WITH ALTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEA2(DETECTOR 3.0 GPM TEST WTIH ALTO PUMP SHUT OFF FOR LEAK <br /> LEN)SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE,MIO SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS <br /> ALARMS - 2. MONTHLY 0.2 GPM TEST <br /> 0 2 MONT1LY02GPH TEST <br /> .� ] ANNUAL INTEGRITY TEST(0.1 GPM) 1 <br /> C3 3.ANNUAL INTEGRITY TEST(OA GPM) <br /> 10 4. DAILYVISUALCHECK <br /> CONYEYRO.VAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check ae Nat appy): <br /> 0 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY 0 5 ONLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> TEST III I GPM) ❑ 6 TRIENNU,LINrEGRT'TEST(0.1GPH) j <br /> ,..FE SUCTION SYSTEMS(NO VALVES IN BE,OW GROUND PIPING) SME SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> 0 7. SELF MONITORING 10 7. SELF MONITORING <br /> I <br /> GRAVITYFLOW GRAVITYFLOWXCA a4Natappy): <br /> 0 9. BIENNIAL INTEGRITY TEST(0.1 GPM) 0 a. OALYVISUALMONITORING <br /> 0 9 BIENNIAL INTEGRITY TEST(0.1 GPM) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PR=SSURIZEO PIPING(CAe as mar appy): PRESSURIZED PIPING(Check a0 that appy) <br /> 10. CONTINUOUS TURBINE BUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL AIARM3 AND(tl4ck ma)i <br /> ❑ a. AUTO PUMP SHUT OFF WHEN A LEA)(OCCURS 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 E. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM1t ❑ D. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION <br /> DISCONNECTION <br /> 0 c NO AUTO PUMP SHUT OFF 0 c NO AUTO PUMP SHUT OFF <br /> 0 11 AUTOMATIC LINE LEAK DETECTOR(3.O GPM TEST)WITH FLOW SHUT OFF OR 10 11. AUTOMATIC LEN(DETECTOR <br /> RESTRICTION <br /> 0 12. ANNUALINTEGRITY TEST(0.1 GPM] <br /> ❑ II.ANNUAL INrGRT'TEST(0.1 GPM) <br /> SUCTIONfGRAVITY SYSTEM: SUCTIO WGRAVITY SYSTEM' <br /> 0 13 CONTINUOUS SUMP SENSOR.AU03LEANO%9SUA-ALAAMS 13 CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS ! <br /> EMERGENCYGENERATORS ONLY(Che .11IabappY) EMERGENCY GENERATORS ONLY(Ceeckas Nat appy) <br /> 1014. CONTINUOUS BLIMP SENSOR WIT_HOOTTALTO PUMP SHUT OFF•AUDIBLE AND 1011. CON71NUOUS SUMP SENSOR WITHO ALITO PUMP SHUT OFF AUDIBLEMO%1$UAL <br /> VISVALA:ARMS ALARMS i <br /> 1015.AUTOMATIC LINE LEAK DETECTOR(3 0 GPM TEST)WATHOUTFLOWSHUTOFFOR I D IS.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) <br /> RESTRICTION <br /> 0 15. ANNUAL VEMGRITY TEST(0.1 GPM) 0 16.ANNUAL INTEGRITY TEST ITT GPM) <br /> 1.017. DAILYVISVALCNECK ❑ 17. ONLY VISUAL CHECK <br /> .VIILDISPENSER CONTAINMENT <br /> DISPENSERCONTA4NMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4. DAILY VISUAL CHECK <br /> DATE INSTALLED 468 ❑ 2. CONTINUOUS DISPENSER PML SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCHUNER/MONITORING <br /> ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑ 6. NOME 4891 <br /> ):IX.OW N E MPERATO R SIGNATURE <br /> w:v ' Don P'ovEaE Ber Man6 4b01e M4LNmy bwvkd9s_• .... .: <br /> SIG RE_ F ER/OP TOR 1 DATE 470 <br /> EOF PEMTORremo 471 T OWNER/OP TO 472 <br /> mC, <br /> Pinna NU (Fpr local use qtly) 473 1 Pama ApprorM(FP•taaal useoM'1 474 I Pa1ml ENgaalian Date(Far/xal use onyl 475 <br /> I <br /> UPCF(1199 revise) 7 Formerly SWRCB Form B <br />