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01/08/2004 08:23 209468jQ3 FIFTH FLOOR _ PAGE 21 UNIFIED PROGIUM CONSOLIDATED FORM TANKS UNDELGROUND STORAGE TANKS-TANK PAGE 2 ... ... _.._._ ...... ...-..._._lo3i-'.;:.._....:.:'"i�'".'p'1�'1•�.Y'i�11V :Y:o .:.: - _ aw.,: .ST'It13.CTIO)V; k:n1)4a4La• ...la... ., i;V«%• '0w:7�w,av:p:�':'�:;N:31iii-,.®�rl; �'t`r..:A;ns;•c.: UNDERUROUND PIPING ABOVEGROUND PIPENG -- SYSTEM TYPEt. PR p 2 SUCTION [ 3.GRAVITY 458. p 1.PRSSSURE 0 2.SUCTION LI L GRAVITY -159. CONST RUCTION/ 1.SINGLE WALL ®3.LINED TRENCH MANVIFACTURER ©99.OYHIIt 460. ❑I.SINGLE WALL Q95_UNKNOWN a51. 2.DOUBLE WALL p95.UNKNOWN ®2.DOUBLE WALL 99,OTIMP MANU ACrURFR 46L MANUFACTURER p 1.BARE STEEL 6.FRP COMPATIBLE W110W.METHANOL ®t.BARS STEEL p 6.FRP COMPATIBLE WII00Yo METHANCI_ p I STAINLESS STEEL 7.GALVANIZED STEEL Q 2"STAINLESS STEEL ❑7.GALVANIZED STEEL. ❑3.PLASTIC COMPATIBLE WITH CONTENTS a 95.UNI(MOWN ❑3.PLASTIC COMPATIBLE W/CONTENTS ©8.FLEXIBLE(HE PE) O.W.OTHER ❑4.FIBERGI-ASS ❑8_FLEXIBLE(HDPE) [3 99.07HER 0 4,FIBERGLASS 0 9.CATHODIC PROTECTION [7 5.STEEL WICOATING {y0 yr9.CATHOl+DI IP,ROOTy�EyCyyT.IIO(Nw�y M,�} 464• ❑5.STEEL WfCOATING 0.95.UNKNOWN -a;5. :il'.UULY v.i.\.r .'� Y:�,iiSfa>,fV+.6"..A EYe•rlAOf a.\0.+�9R�IIIlllI:6 y •1S � :1..'a•.K..:::.:I..m::.:• :....... . .•-.• ••':"•. t Ktl Oti1176'mlKalO!}....''..•• Yht"t46e w.a>rma'W tti61aai1:-••••.. :r.�l-J r+...��v - •...'.�..^.t:•it9t PIPING SINGLE WALL PIPING UNDERGROUND PIPING 466, SINGLE WALL PIPWG ABOVEGROUND461 PRESSURIZED PIPING(Check all that apply); PRESSURIZED PIPING(Cheek all that apply} ❑1• ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST W[TM ALTO PUMP ❑I. ELECTRONIC LINE LEAK DETECFOR.3.0 GPM TF--;T WITH AU110 PUMP SHUT-OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION SWJT OFF FOR LEAK.SYSTEM FAILURE,AND SYSTEM 015CONNSCMON +AUDIBLE AND VISUAL.ALARMS. +AUDIBLE AND VISUAL ALARMS, p 2. MONTHLY 0.2 GM TEST [12. MONTHLY 0.2 OPS TEST 03. ANNUAL INTEGRITY TEST(0.1 GPH) [13. ANNUAL INTEGRITY TEST(0.I GPH) ❑4. DAILY VISUAL CBECK CONVENTIONAL SUCTION SYSTEMS CONVEiv'ITONAL SUCTION SYSTEMS(Check all that apply) 0 S. DAILY VISUAL INTEGRITY TP-ST( 10 GpMONITORING OF PUDSPB tO SYSTL'M+TRIENNIAL PIPING p 5. DAILY VISUAL MONITORING OP PJTINC AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING); 06. TRIENNIAL INTEGRITY TEST(0.1(3PH) Q?. SELF MONITORINO SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GRCLIND PIPWG): GRAVITY FLOW ❑7. SELF MONITORING [19. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): CIS. DAILY VISUAL MONITORING [19. DIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply); PRESSURIZED PIPING(Chuck alt Ont apply): 10, CONTINUOUS TURBINE SUMP SENSOR-V= AUDIBLE AND VISUAL 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VLS'1A!. ALARMS AND(Chock one) ALARMS AND(Check OIG) 13 .AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a_AUTO PUMP SHUT OFF WHEN A LEAK OCCURS T AUTO PUMP SHUT OF?FOR LEAKS,SYSTEM FAILURE AND SYST12M 0 t5,AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM! DISCONNECTION DISCONNECTION pc. NO AUTO PUMP SHUT OFF ©c. NO AUTO PUMP SHUT OFF 11. AUTOM OTIC LINE LEAK DETECTOR(3.0 GPH TEST)-WITH FLOW SHUT OFF OR RESTRICTION ®11.AUTOMATIC LEAK DrMCTOR 12. ANNUAL INTEGRITY TEST(0.t GM ❑12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONIGRAVITY SYSTEM SUCTION/GRAVITY SYSCEM ❑t3- CONTINUOUS SUMP SENSOR+A(1DMLE AND VISUAL ALARMS ❑13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EM£RG&NCY GENERATORS ONLY(Clink all that apply) EMERGENCY GENERATORS ONLY(Chock all.that apply) ®14.CONTINUOUS SUMP SENSOR WFMO T AUTO PUMP SHUT OFF [314.CONTINUOUS SUMP SENSOR WITHOCI C AUTO PIMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑IS_ AUTOMATIC LINE LEAK DETECTOR (3.0 OPM TP.M WITHOUT FLOW SHUT OFF OR RESTRICTION 015.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) [116. ANNUALDnTm0RITYTE$T(0.I GPI•p 0 16,ANNUAL INTEGRITY TEST(0.1 GPH) E337. DAILY VISUAL CHECK Q 17_DAILY VISUAL CHECK •i.fi• •i;?- r;eXa alFc a;ni&a"Ijr•". :�:'r,� �M. •la-cx,.ii'' .;+r:l�rrag:: u:rx:ua;-'.ru xucYa• ::vn•r., .r•�..•:• �Ic"AX.i+�: .SEI �;' TrA:I1VIMKT(I_.''i+.'+: w.�K•,•nan:-:.tiMarP.x,.»., 'r.rn+,n'. - ,>,ii';jni•i•<:::. DISPENSER CONTAINMENT 463 nil. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE y. 'DAILY'` AL CaECK 460. DATE INSTALLED 2_ CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5. TRI NCE/11NER V ONITORLiIG CONTINUOUS DISPENSER. PAN SXNSOR WITH AUTO SHUT OFF FOR C7 NONE p.... . .,..._.... ,a..,.,.;..» AUDI ... ....>. .im _.. + BLE AND VISUAL ALARMS � ...... ye:l:.;:e"`:l:i::.:�p'.:';ilsGr:• :......... .J... -a..•c-.nn. ::... '' V4 AGftr✓1h-oF .p .2•i'. ,... :._..u. - _. _.... �.....,.. �. ��LNa'vJ�'_-_ a•�1..art p•: _ t certify that the information rovWd h ,•.P:._1,.:l�..r,.,.w r•-" - p orcin i true at+d orate t0 the:bast of my knowledge_ SIG.ATURE OF OW DATE: NAM FONN PERATOR(print. TITLE O OWN OP TOR: 473 � of �1�tJ�l"A/ oI✓N�lL Permit Number(Ag:nry vee only) 473 Famut Approved By(Agency un oOWY) 474 Pwmit ExPitation tate(Agemy We pnly) 47; UPCF htvfwrc-b(1199).3/4 bU J/www-nnedaca oq, Rcr.02/16/70