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UNIFIEO PROGRAM CONSOLIOATE-O FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> VL PIPING=hSTRUC'CN:C ocxaJ2ataaoN/ <br /> =-MINAaC'.SGACI�NO MIMING <br /> -PSSSL.qS SL:C-CN ❑ :;;IAV:-'! -QEjSNRE SUCT:CN ;R,1•;1-• <br /> iCGN574•_C"Ca, «4E0 TRE4G`7 L...39. J;'!-rcR I 1_2SiNG:_NAL- - _ r-"35. UNxNCNN <br /> MANUc A�•RcR (�;. 3JU3L_'NAL_ 35. 'UNKNOWN ❑ CCUBL".".u. 'ter,`99. OTH<R <br /> I MANUFACTURER �' .MANUFACTURER - <br /> 1 BARE jTE= L' S. =RP CCMPAT18L3'N)100Y.METHANCL G BARE STEEL ❑ 5• FRP CCMPATIBL Wt 100!4 ME-i-INC: <br /> MATERIALS AMC Cl 2 STAINL W S7_EL G GALVANIZ D ST-eEL G 2 STAINLESS L Cl 7. GALVANIZE.)+ STEELST � <br /> CCRRCSCN i <br /> ;)ROTE,-,CN G 3. -IASTIC CCMPATI8LE'MrH CCt4MNTS Cl 95. UNKNOWN ❑ 3. -,-ASTIC CCMPAneLE WITH CONTENTS ❑ i FLJ08L(NCP£) r'99 OT.-_R <br /> [334. FIBERGLASS n 3. :-I)DBL?;NOPE Cl 99. OT+ 4 ❑ I FIBERGLASS C B. CATHCCiC PROT'cC:ION <br /> ❑ 5. STE2L'.aCc:A.ING ❑ 3. CA;HCSCPROTC-,'TCN ❑ 3. S,.EL'MC^.A'NG C3i UNKNOWN <br /> i V11.PIPING LEAK DETEC710N(GNexadawsop" <br /> I _ <br /> UNCEPGRCUNO PIp NG A8CVEGRCUN0 PIPING <br /> SINGLE WALL PIPING SINGLE WALL PIPING <br /> PRESSURIZED PIPING(Ctect as that aomM: 7ocSSURIZS0 PIPING(C-N&L Mw aopyt. •I <br /> ❑ 1. RCNIC UNE LEAK CETECTCR 3.0 GPM T=ST'.MTH AUTO PUMP SHUT CFF FOR ❑ 1. ELECTRONIC LINE LEAK CIBTECTCR 3.0 GPM TEST HATH AUTO PUMP SHUT OFF FOR LEAK. !I <br /> LEAK' <br /> EAK.SYSTEM FAILURE ANO SYSTEM CISCCNNEC:ICN-AUCIBL= -,EIA ANO VISUAL SYSFAILURE ANO SYSTEM CtSCCNNEL'iCN•AUCI8LE ANO VISUAL ALARMS i <br /> ALARMS f <br /> f❑ Z !ACNTHLY 0.3 GPM-ST Cl 2 .MCNTHLY 0.Z GPM TES"' 1 <br /> ❑ 3. ANNUAL INT_-raR1TYi ST m.I CTD) <br /> ❑ 3.ANNUAL.NTEGRITY-ji!0.1 GPM) i <br /> i <br /> ❑ A CAILY'ASUAL CHECK <br /> ' 1 <br /> CCNVENTICNAL SUCTION S'(S7E.M5: CCNVE4T:CNAI SLAC-CN SYSTEMS(GNu ad ant aooy): <br /> ❑ 3. CAT!':SUAL.MCNITCRL`IG CF°LIMPING SYS-,VII-BIENNIAL PIP'NG INTcGRI-' i. CAILY VI$WL MCNTTCRING OF PIPING ANO PUMPING SYS`!A <br /> QST(0.I GPM) ;❑ i. -IENNIAL:NT_-GR17Y=S:A.I GPU) - <br /> SAFE SUC-MCN SYSTEMS(NO VALVES IN BELOW GRCUNO PIPING: SAF_SUC-CN SYSTEMS(NO VALVES iN 3E74VGRCUNO PIPINGI. <br /> I❑ 7 SEF MCNITCRING C 7. SEF MCNITCRING <br /> I <br /> GP.- ^�r GRAVmFLOW(Choatamatsooy): <br /> L vE4NIAL:.V TEGRITYcST;0.1 GPM) ❑ S. CAILY VISUAL MCNTTCRING <br /> I I <br /> I ❑ 3. BIENNIAL INTETEST ST(O.1 GPM) f <br /> t I <br /> SECONDARILY CONTAINED PIPINGi ^ SECCNOARILY CONTAINED PIPING _ ' <br /> 'PRESSUPIZ° G'D PIPING(Clyea/mar so^: PRESSURIZED PIPING(Caen as NF cooly): <br /> 10. ^^:ITIN000S TURBINE SUMP SENSCR,M-..4 AUCISL=ANO VISUAL ALARMS ANO <br /> 1 aa:t. an.I 1 •0.C::NnNUCUS TURBINE SUMP SF-4SC.R.MTM AUClaLZ ANO ASLAL ALARMS ANO•_. tx rW <br /> R a AUTO PUMP SMUT CFF'.%s._N A L=>K CCCORS Lr a. AUTO PUMP SHUT CF='M•E4 A t-ZAK CC-'RS <br /> 4V7 AUTO PUMP SHUT CFF=CR LZAKS.SYSTEM FAILURE AMC SYST'•-'M <br /> G <br /> 3.SCCNNE,':CN I a. AUTO PUMP SHUT CFF FC --.F-AKS.SYSTEM FAILURE ANG SYSTEM CISCCNN_-Cs <br /> C c :10 AUTO PUMP SHUT CFF ❑ n 40 AUTO cGMP SHUT;FF <br /> i 4 11 AU T, UNE LEAK CET^, CR(3.0 GPM'EST)'.MTM FLCN SHUT CFF OR G 11 AUTCMATIC LEAK CET cGCR I <br /> ?EjTRfCT10N <br /> 3 12 ANNUAL INTEGRIN TES7,(0.1 GPM) G 17- ANNUAL INTEGRITY TEST(Q.1 GPti) <br /> SUCTIC.4(GRAVITY SYSTEM: SUC-CuGRAVITY SYS.cY. i <br /> ❑ 13. CCIITI14000S SUMP SEYSCR-AUC18LE ANO VISUALALARMS ❑ 13. CONTINUOUS SUMP SENSCR•AUG8L=ANO VISUAL ALARMS j <br /> EMERGENCY GENERATORS CNLY(Coat ad mat appy) EMERGENCY GENERATORS ONLY(Ct.eX as mat sop" <br /> ❑ IA. CCNTINUCUS SUMP SENSCR WlTHCUT AUTO PUMP SHUT CFF-AUDIBLE ANO ❑ •a C..NTINUCUS SUMP SE4SCR'MTHCUT AUTO PUMP SMUT CF=-AUCIBLL ANO VISUAL <br /> IASLAL ALARMSALARMS <br /> G is. AUTCMA^,C UNE LEAK CETECTCR(3.0 GPM TES)wtTHCUT FLCW SHUT OFF CR I G 15. AUTCMATIC UNE L_cAX CETcCTCR,J.0 GP4-.EST) <br /> j <br /> RESTRIC-C.4 li <br /> Cl 16. ANNUAL;NTEGRITY,EST(0.I GPM) I Cl I.S. ANNUAL INTEGRITY TEST(0.1 GPM) <br /> ❑ 17. CAILY'4SUAL CHECK ❑ 17. CAILYVISUALCXECX <br /> VBL MSP£4SER OCNTAINMENT <br /> CISPENSeR C 14TAINMENT Cl 1. FLOAT MECHANISM THAT SHUTS OFF SMEAR VALVE Cl 4. CAILY VISUAL CHECX <br /> CAT=:NS7AL_0 ❑ Z. CCN T IMUCUS.:SP_11SER PAN SENSOR-AOGBLE ANO VISUAL ALARMS ❑ 5. 7RE4C4UNE.R l MCNrTCRL4G <br /> IO' La�J ❑ 3. CONTINUOUS 1SPENSER PAN SEA=R WITH AUTO SHUT CFF FOR CISPIISER-AUDIBLE AMC VISUALALARMS ❑ 6. NONE <br /> UL CWNEPJCPERATCR SIGNATURE <br /> I Earory S.al.^..1nhlT.latgn a1E`r'G.at�anM'3 tIY.arq aC�9t.EI af.'cost et my knaN.EQ.. <br /> SIGNAiLP CF CWNEPfCPERAiCR CAT— <br /> LwME CF 7,%NEsPJCPERATCR(:.'M i-OF CNNER CPERATCR i <br /> Pw. mer(Fw/or..0 va.ocy/ P.rivt APotovw(F!i(eu1 w.ony) Penmt Eaa-0c.C"(For weal W.:nry) <br /> i I <br /> :UPAF'^,rRJ.t:4;97) Fornerty Sv.RC3;:rm 3 <br />