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UNIFIED PROGRAM CONSO IDATED FORM TANKS UNDERGROVND STORAGE T NNKS - TANK PAGE 2 VI.PIPING CONSTRUCTION Check all t we apply) Page.Cof•I UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 459 ❑ 1.PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 CONSTRUCTION ❑1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 460 ❑ 1.SINGLE WALL ❑95.UNKNOWN 462 MANUFACTURER ®2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER _ Smith Fiberglass 461 MANUFACTURER 463 ❑ 1.BARE STEEL ❑6.FRP COMPATIBLE w/100% METHANOL ❑1.BARE STEEL [:16.FRP COMPATIBLE WA00/METHANOL Cl 2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑Unknown ❑2. STAINLESS S FEEL [17.GALVANIZED STEEL [13.PLASTIC COMPATIBLE W!CONTENTS ❑99. Other ❑3. PLASTIC CON IPATIBLE W/CONTENTS [18.FLEXIBLE(HDPE) [199. OTHER N 4.FIBERGLASS [18.FLEXIBLE(HDPE) ❑4. FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 464 [IS. STEEL W/CO TING [195.UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that apply)(A dtscri tion of he enonitoring program shall be submitted to the local a cocy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 I PRESSURIZED PIPING(Check ail due apply): PRESSU RIZED PIPING(Check all that apply): Ell.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+ SIFUT 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(O.1GPH) ❑3.ANNUAL INTEGRITY TEST(O.1GPM ❑4. D LY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CO TIONAL SUCTION SYSTEMS(Check all that apply) [15.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING ❑S. DMLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6. TI U20UAL INTEGRITY TEST(0.1 GPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7. S LF MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVI1Y FLOW(Check all that apply): ❑8. D LY VISUAL MONITORING Cl 9, 81 ENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSU RIZED PIPING(Check ail that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CMITFINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Chock one) ALUUMS AND(Check one) ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ®b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑E 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)WITH FLOW SHUT ❑11. UTOMATIC LEAK DETECTOR OFF OR RESTRICTION ®12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. iNNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM - SUCTIC N/GRAVITY SYSTEM [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• ❑ 14. coNrwuous SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF` AUDIBLE AND VISUAL ALARMS ' UDIBLE AND VISUAL ALARMS E315. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW 015. UTOMATIC LINE LEAK DETECTOR(3.0 OP14 TEST) SHUT OFF OR RESTRICTION ©16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑16. UAL INTEGRITY TEST(0.1 GPH ❑17. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VIII.DISPENSER CONTA INMENT DISPENSER CONTAINMENT ❑ 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTALLED 468 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE Ah D VISUAL ALARMS ❑S.TRENCH LINER 1 MONITORING 2003 El 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTOS OFF FOR C-16.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS LTC.OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accuraze to the best of my knowledge;- S1G EOFOWN€RlOPERATOR DATE 470 N l�Wt1fF�OPRA OR(pA 471 TITh F O D OAR 47' aN1 Vdl • 1 Permit Number{Far local use only) 473 Permit Approved(Far local use only) 474 Permit Expiration Date(For local use only) 475 UPCF(12199 revised) 12 Formerly SWRCB Form B