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• 'I UNIFIED PROGRAM CONSOLIDATED FORM o ` <br /> TANKS <br /> 4 UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> I <br /> VL PIPING CCNSTRUC7CN(C'>acr ad matacoy) <br /> a NCE?OPCCNO PIPING ABCVEGRCUNO PIP-NG <br /> SYSTEM-CS r ••, <br /> 1 PoE55i;RE -T 3SUC:'1CN ❑ 1 GRA'JiT`l!L: oRESSURE Cl❑ 2. SUCTION ❑ 3. w"tAvl:r <br /> SINGLE•PaLL ❑ . LINED TRENCH ❑39 C-,' ER C! I SINGLE WALE ❑95. 'UNKNC'NN <br /> CONST?LC^Cw ❑ � I <br /> .NANUFAC,;RER Z. 30UaLE WALL ❑95. UNKNOWN ❑ 2. CCI:BL='WALL ❑99. OTHER <br /> MANUFACTURER MANUFACTURER <br /> ❑ 1 BARE STEL ❑ S. FRP COMPATIBLE W/100%METHANOL G 1. BARE STEEL ❑ 9. FRP CCMPATIBL--W/100-MET1+A.4CL j <br /> MATERIALS AND ❑ Z. STAINLESS STEEL Cl 7. GALVANIZED STEEL EEL Cl 7- STAINLESS STEc'L ❑ 7. GALVANIZED STEEL <br /> CORRCSICN <br /> PROTtC71CN Cl 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC CCMPATIBLE WITH CCNTENT5 ❑ & FLEMBL3(HOPS) ❑99. OT!-?i <br /> 4. FIBERGLASS ❑ S. FLEXIBLE(MOPE) Cl 99. OTF.E.R ❑ a. FIBERGLASS Cl 9. CATHCOIC PROTECTICN <br /> ❑ <br /> S. STEEL'.VPCOATING Cl 9. CATHCDICPROT'ECTTCN ❑ 5. STEEL`N/CCATIMG ❑95. UNKNOWN <br /> IAL PIPING LEAK DETECTION(CtleekaddWappW <br /> UNCERGROUNO PIPING A80VE-GRCUNO PIPING <br /> SINGLE WALL PIPING SINGLE WALL PIPING <br /> PRESSURIZED PIPING(C1eUt ail mat apply): PRESSURIZED PIPING(C%ck a/mat aoPM= <br /> ❑ 1. ELECTRONIC UNE LEAK CE-.ECTOR 1.0 GPM TEST'MTM AUTO PUMP SHUT OFF FCR Cl 1. ELECTRONIC UNE LEAK DETECTOR 1.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK <br /> LEAK.SYSTEM FAILURE AND SYSTEM OISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE AND SYSTEM DISCONNECTION-AUCISLE AND VISUAL ALARMS <br /> ALARMS <br /> Cl Z MONTHLY 0.2 GPM TEST <br /> Cl 2. MCNTHLY 0.2 GPM TEST <br /> Cl 3. ANNUAL INTEGRITY TEST(0.1 GF'!) <br /> Cl 3.ANNUAL INTEGRITY TEST!0.1 GPM) Cl <br /> A. DAILY VISUAL CHECK <br /> CONVENTIONAL SUC^CN SYSTEMS CONVENTIONAL SUC7ICN SYSTEMS(Cllef]a ad teat apply): <br /> Cl 5. DAILY VISUAL MCMITCRING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY I❑ S. CAILY VISUAL StOWTORING OF PIPING AND PUMPING SYS,-_M <br /> TEST;0 1 DPMI Cl 5. TRIENNIAL INTEGRITY TEST Ia.I GPM) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): $APE SUC7ICN SYSTEMS(NO VALVES IN 9ELC'NGROUN0 PIPING): <br /> ❑ 7 SELF MONITORING Cl 7. SELF MONITORING <br /> GRAVITY FLCve GRAVITY FLOW(CMck at mat appy/: <br /> [I 'IE4NIAL INTEGRITY TEST Io.1 GPM) ❑ 9. DAILY VISUAL MONITORING <br /> Cl 9. al ENNIAL INTEGRITY TEST(O.1 GPM) <br /> SECONOARILY CONTAINED PIPING SECCNOARILY CONTAINED PIPING I <br /> PRESSURIZED PIPING(Chad as mat appy): PRESSURIZED PIPING(C.'100 ad Mat aoPO - f <br /> 10. CCNTNUGUS-URSINE SUMP SENSCR'MTH AUDIBLE AND VISUAL ALARMS AND <br /> 10.CONTINUOUS TURBINE SUMP SE45.:R`NTH AUCIBLE AND VISUAL ALARMS AND(�rat ale! <br /> MIf <br /> Cneu one) <br /> �p a. AUTO PUMP SHUT CFF'AMEN A LEAK OCCURS I G a. AUTO PUMP SHUT OFF' ME.4 A LEAK OCCURS <br /> y� o AUTO PUMP SMUT CFF:CR{SAxS.SYSTEM FAIL'.'RE ANC SYSTEM ` <br /> O.SCCNNECTICN ❑ 7. AUTO PUMP SMUT CFF FCR L=AKS.SYSTEM FAILURE AND SYS-=.M CISCONNc CN <br /> �.,/ ❑ c VCl c N <br /> O AUTO PUMP SHUT OFF I o AUTO PUMP SHUT OFF <br /> Ll 11 AUTCMA TIC UNE LEAK CETECTOR(3.0 GPM TEST)'MTM FLOW SHUT OFF OR I❑ 11_ AUTOMATIC LEAK CETE=R <br /> �y RESTRICTION <br /> Le 12. ANNUAL INTEGRITY TEST(0.1 GPM) ;❑ 12. ANNUAL INTEGRITY TEST(0.1 GP") <br /> SUCTICWGRAVITY SYSTEM: SUCTICNGRAVI Y SYSTEM: <br /> ❑ 13. CCNTINUCUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR-AUCIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(CAack as mat appy) EMERGENCY GENERATORS ONLY(CNack aI mat SOPM <br /> ❑ 14. CCNTINUGUS sump SENSOR wtTMOUT AUTO PUMP SMUT OFF-AUDIBLE AND ❑ 1+. CONTINUOUS SUMP SENSOR WIT)ACUT AUTO PUMP SHUT OFF-AUDIBLE AND VISUAL <br /> VISUAL ALARMS ALARMS <br /> IJ 15. AUTCMATIC UNE LEAK DETECTOR(3.o GPM TEST)WITHOUT FLOW SMUT OFF OR Cl ti AUTOMATIC UNE LEAK DETECTOR-3.0 GPM TEST) <br /> RESTRICT;CN <br /> ❑ 16. ANNUALINTEGRITYTEST AlGPM) ❑ 10. ANNUAL INTEGRITY TEST(0.1GP4) <br /> ❑ 17. GAILY VISUAL CMECK ❑ 17. DAILY VISUAL CHECK <br /> VUL MPENWA CONTAINMENT <br /> CISPE45ER CONTAINMENT I. FLOAT MECHANISM THAT SHUTS OFF SMEAR VALVE ❑ a. DAILY VISUAL CHECK <br /> CA/.'INSTA LL_C0 ❑ 2.CCNTINUOUS DISPENSER PAN SENSOR-AUCISLE AND VISUAL ALARMS ❑ S. TRENCH LINER/MONRORtNG <br /> /V r V' r WDd ❑ 3. CONTINUOUS CISPENSER PAN SENSOR`MTM AUTO SHUT OFF FCR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑ E. NONE <br /> �- I <br /> IX OWNEAICPERATOR SIGNATURE <br /> I cant'rat:'ta inhm.+Soon -e ova and amrate 10 die IHat of My kn4.Ab9e. <br /> SiGwTUR° c TOR DATE <br /> 3 �A, r <br /> .NAME VAN ERr_ � <br /> PE CR TITLE OF OWNERCPERATCR I <br /> Wm <br /> ?I n:er(9o,W-W uaa ory) Pemut Apor .d(Pot local uaa o"M Pennd E=raoan Dau(",vcat w 7n1y1 <br /> • I <br /> -UPAFCRM(4r99) Forrnert-/ <br />