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01/08/2004 08:23 20946830FIFTH FLOOR PAIGE 21 UNIFIED PROGRAM C070LIDATED k'®RM ' TANKS UNDERGROUND STORAGE Tt+1,.NXS-r TANK FAGS 2 Page_of - •a:.l'i1N:n1RNIv ,:1.•^. �:l�P:N:.•1:^ .rl•.l.n.l:r '�.: 1;� .'R'• �:1:112°_. :.�i:r..4' li+`;.N.:'�w1.-`• .r„•a-..n.:1 •'^'t .^•:'>'dn8`.BSVLMI.!LV�.l7'8"11�CiiNLR�N;'i .}IG _:f. /.tla.w>..tlu-M••: ..{. .Y.'.'.r.b.'ra,• UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE L PRESSURE ❑z SUCTION [13.GRAVITY 454- ®1.PRESSURE ®2.SUCTION Q 1.ORAVITY 456r. CONSTRUCTION/ 1.SINGLE WALL ❑3.LINED TRENCH C3 99,OTHER 460_ )]1.SINGLE WALL Et95_UNK MOWN 451. MANVFACTURER .DOUBLE WALL [195.UNKNOWN Q 2.DOUBLE WALL Q 99.OTHER RTNUFACTURER 461. MANUFACTURER 4,Z- Ll 1.BARE STEEL FRP COMPATIBLE W/100%METHANOL ®I.BARE MEL ®6.FRP COMPATIBLE W1100%METHANOL J2 2.STAINLESS STEEL 7-GALVANIZED STEEL Q 2.STAINLESS STEEL ❑7.GALVANIZED MEL ❑3.PLASTIC COMPATIBLE WITH CONTENTS ®95.LNKNOWN ®3.PLASTIC COMPATIBLE WJ CONTENTS ©8.FLEXIBLE(HC PE) Q 9%OTHER. 0 4.FIBERGLASS ®S.FLEXIBLE(HDPE) 0 99.OTHER Q 4.FIBERGLASS [19.CATHODIC PROTECTION ❑5.STE5L W/COATING {0 9.CATttHO�•DIICPPOOTECCryTrIIO/Nvry y w 44K ®S.STEEL WICOATING ❑.95.UNKNOWN a>S. 4N tla� a�•TL•16.f:L`�;u+V'�tit�AVVAdOI'[-L@'Glfl� ul, .• ( T Piil` -tihdm'ioosai' flieltiKw�'o6ie�toisd'IOcnl" , ee l 'll� UNDERGROUND PIPING ABOVEGROUND PIPING SXNCLE WALL PIPIING 466. SINGLE WALL PIPING PRESSURIZED PIPING(Check a0 that apply); PRESSURIZED PIPING(Check all that apply): ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESTETH AUTO PUMP [3]. ELECTRONIC LINE LEAK DETECTOR 3.0 GFH TEST WITH AUTO PUhIP SNOT-OFF FOR LEAX_SYSTEM FAILURE,AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. p 2, MONTHLY 0,215170 TEST [12. MONTHLY OZ OPH TEST 3, ANNUAL INTEGRITY TEST(0.7 GPH) 03. ANNUAL INTEGRITY TEST(0.1 GPH) ❑4• DAILY VISUAL CHECK CONVENTIONAL SUCTI0IN SYSTEMS CONVEINTTONAL SUCTION SYSTEMS(Check all that apply) ®Sr DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING [IS. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST A i GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW/GROUND PIPING); [36. TRIENNIAL INTEGRITY TEST(O.1 GPH) ❑7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7. SELF MONITORING E19. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): a& DAILY VISUAL.MONITORING ❑9. mE NNIAL INTEGRITY TEST(0.1 GPI) SECONDARILY CONTAINED PTMG SECONDARILY coNTAINED PIPING PRESSURIZED PIPING(Chuck all that apply): PRESSURIM PIPING(Check all that apply); 10. CONTINUOUS TURBINE SUMP SENSOR EM AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR Wrm AUDIBLE AND V S',A:. ALARMS AND(Chock One) ALARMS AND(Chuck one) a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Q a_AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b.AUTO PIMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYST12M Q b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEd4 FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑c. NO AUTO PUMP SHUTOFF pc. NO AUTO PUMP SHUT OFF ]I. AUTOMATIC LINE LEAK DETECTOR(3.0 GPHT&T*WITH FLOW SWT ❑t L AUTCAIATIC LEAK DETECTOR (I OFFOR USTRICTION 012- ANNUAL iNTEGRTTY TEST(0.I eM - ❑12.ANNUAL INTEGRITY TEST(0-1 GPH) SUCTIONIGRAVITY SYSTENI SUCTION/GRAVITY SYSTEM 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ®13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all tbst apply) EMERGENCY GENERATOPS ONLY(Cheek all that apply) ❑14.CONTINUOUS SUMP SENSOR WPPHOIJT AUTO PUMP SHUT OFF ❑14.CONTINUOUS SUMP SENSOR WTTHOI)T AUTO PIMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS Q75.AUTOMATIC LINE LEAN DETECTOR (30 GPH TEST) WITROUT FLOW 015.AUTOMA77CLINE LEAK DETECTOR(1-0GPRTEST) SHUT OFF OR RESTRICTION ©16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0.1 CPR) E317. DAILY VISUAL CHECK ❑17.DAILY VISUAL CHECK -.al1,• :'V:v -- :�' ;yry -*,,� viii'�FI'H:p Y'..qIH:t:N:ll• v:11 ` 1`4''•tt.N4WeH•-+ •N,IMIMn.3 y.ry..:�.�'. 'R.S:• )hT.�:N^N7(Y DISPENSER CONTAINMENT 4% FLOAT MECHANISM TEAT SHUTS OFF SHEAR VALVE (34. DAILY%7SUAL CAECK 469. DATE INSTALLED r2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5. TRENCUILINER IS•_'ON TORING CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6. NONE DISPENSER+AUDIBLE AND VISUAL ALUMS .x.%13:; ";'i.::':g•::ri ' ...:.:.:,U":t101j+•k v....-.... .... .. -a:•...r.;N:"::::_• �� .ha v1!.'_ M/.: "r:h 1..ir.e a�!+. (certify that the mmg2E�t provided hereinym true,and act tate to the best of my koowW_ir SIGNATURE O PERATOPDATE; ATI D3 ►� a NAME I)r'OnrNERAOPERATOR(pciat); 6 Iy��p7 e . 1 TITLE O E OFTOR: wu ermit Nuoibcr(Agency,use only) "I Pmvdt Approved By(Agteney ase ody) 474, Prom$Bxgurtim Date(Agency Dae only) 473. UPCF Wwre-b(1/99).3/4 ltipJ/wtvw_nnidoaa,org Rev.02/161,,30