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01/08/2004 08:23 2094683433 FIFTH FLOOR PAGE 21
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<br /> UNIFIED PROGRAM'CONSOLEDATY•;D FORM
<br /> TANKS
<br /> --.UNDERGROU"STORAGE TANKS TANK PAGE 2
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<br /> aeAIWFACTUttER l•SNGLEtYATP p3, CH 99,OTHER 460. [3 1.SINGLE WALL 95_UN s51.
<br /> 2.DO WALL p 4s. OWN ®2,DOUBLE WALL Q 90.OMMR
<br /> 461. 1 MANUFACT
<br /> Ell, S .FRP COMPATIBLE full M OL ❑t.BARS ®6 FRP COMPATIBLE W1100%METHANC i,
<br /> ®2 STAINLESS L9.17.OALYA j7 2 STAINLESS STEEL ❑T.GALVaNtZED STgEI
<br /> ❑3,PLASTIC COMPATIBLE WITH CO 0 95.UNKNOWN ❑3.PLASTIC COMPATIBLE W1 C NTS 0 8,FLEXIBLE(HC PE) Q 9),OTHER
<br /> ®4.FteERC1 ASS ❑8_FL LE(HDPE) 0�.®77;t;R 0 4.FIBERGLASS ❑9.CATIiOIlIC PP OTECTION
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<br /> SINGLE WALL PIPING ABOVEGROUND.PIPING
<br /> °0• SINGLE WALL F G cG'
<br /> PRESSURIZED PI G(Case&all that apply): PRESSURIM PmNG(Check an that:fly):
<br /> ❑1, ELECTRONIC LINE LEAr,DET OR 3.0 GPK TEST WITH AUTO PUMIO Q I. ONIC LINE L DETECTOR 3.0 GFH TEST Waal)AU to P'UniP
<br /> SHUT-OFF FOR LEAK,.SYSTEM FAILURE,AND SYSTEIZ RiCONNECTION SHUT OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM D14CONNwnow
<br /> +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL.ALARMS,
<br /> 0 2. MONTHLY 0.2 QM TEST
<br /> E3 2. MONTHLY 0.2 c1Fi4 TEST
<br /> 03, ANNUAL INTEGRITY TEST(0.1 ram) 03. ANNUAL INTEGRITY TEST(Q.1 GPI)
<br /> E3 4. DAILY VISUAL CHECK
<br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTIONS S(Check all that apply)
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<br /> S. DMLYINTEGRITY
<br /> VISTAS T(0.1 G NG OP PUIaiPNq SYSTEM+ AL PIPINO E35. DAILY VISUAL MONITORING OI•PIPING AND PUMPING S°..'STEM
<br /> SAFE tNTECIRTrY TEST(0,1 LPH)
<br /> SUCTION SYSTEMS(NO VALVES IN BeLow GROUND PtPDIG)t 136- AL DMGRiTY TEST(0.I GPH)
<br /> p a• SE'LP NUTORtNG SAFE SUCTION SYSTEMS(N0 VALVES IN BELOW GRC UND PtPtNG):
<br /> GRA n0W p 7, SELF MOWTORLNG
<br /> 09. BIENNIAL INTEGRITY TEST(0.1 GFH) GRAVITY FLOW( all that apply):
<br /> ❑8. DAILY VWAL RING
<br /> [39. B AL INTEGRITY TEST(0.1 LPH)
<br /> SECONDARILY CONTAINED G SECONDAIMY CONTAMD PIP
<br /> PRBSSURMD r1MG(Check ol1 ly): P D PIPING(c1mv all thea ly);
<br /> 10. CONTINUOUSTURBINF, SUMPSENSOR= AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WIW AUDIBLE AND VIS'.,.&l
<br /> ALARMS AND(Chock oat) ALARMS AND(Check one)
<br /> ❑ .Auto PUMP SHUT OFF WHEN A LEAK OCCURS ❑a.AUTO PUMP SHUT A LEAK OCCURS
<br /> b.AUTO PUMP SHUT OFF SYSTEM FAIL URE AND sYSTFM
<br /> =CONNECTION 13 b.AUTO PUMP SHUT OFF FOR LRAICS,SYSTEM FAILURE AND SYsrEm
<br /> D CTION
<br /> pc. NO Q PUMP SHUT OFF Qc NO AUTO P OFF
<br /> 11. AUTOMATIC LEAK DETECTOR(3.0 GPIs.TEST)1,prrm FLOW SqU C
<br /> OFF OR RESTRICTION Q 11.AUTOMATIC LEAK DMCTOR
<br /> 12. ANNUAL INTEGRITY TEST(0.1 G8H) EJ 12.ANNUAL lwwmny TEST(0.1 GPii)
<br /> SUCTIONIGRAVIrry
<br /> SUCTION/GRAVITY SYSTEM
<br /> ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS Q 13.CONTMUOUS SUMP SENSOR+AUDIBLE AND VISUAL AL4RMS
<br /> EMXRGENCY GENUATORS ONLY(Clmkal116at apply) EMERGENCY GENERATORS ONLY(Chact all that apply)
<br /> ®I4_CONTINUOUS SUMP SENSOR AUTOPUMP SHUT OFF 14,CONTINUOUS SUMP SENSOR WI AUTO P•7MP SHUT OFF
<br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS
<br /> n I5.AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TQST) Mg= FLOW
<br /> SHUT OFF OR RESTRICTION Q15.AUMMA77C LM LEAK DETECTOR(3.0 OPH TES7)
<br /> ®16, ANNUAL YTEST(0,l GPU) ®34.ANNUAL INTEGRITY TEST(0.1 GPH)
<br /> E317- DAILY VISUAL CHECK p 17.DAILY VISUAL CHECK
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<br /> DATE INSTALLED ❑4. DAILY tTSUAL C AGK 46f1-
<br /> S CONTIN DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS p 5. TRPNCti'1L VONTTORLNG
<br /> US DISPENSER PAN
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<br /> DISPENSER+AMBLE AND VISUa ALARMS 0 6. NONE
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