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UNIFIED PROGRAM CONSOLIDATED FORM TANKS \-A, <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 q, n <br /> VI.PIPING CONSTRUCTION Cb=ck all thea I I ABOVEGROUND PIPING <br /> UNDERGROUND PIPING 3.GRAVITY 459 <br /> 95.UNKNOWN 46x <br /> SYSTEM TYPE I.PRESSURE (]2.SUCTION ❑3.GRAVITY 458 0 I.PRESSURE 0 2. SUCTION <br /> CONSTRUCTION 0I.srNGLEWALL ❑3.LINEDTRENCH ❑99.OTHER 4� 02.DOUBLE WALL OTHER <br /> MANUFACTURER eq2.DOUBLE WALL 095.UNKNOWN <br /> 461 FIANUFACTURER <br /> MANUFACTURER ❑b.FRP 1.BARE STEEL COMPATIBLE W/IO METHANOL <br /> 01.BARE STEEL 06.FRP COMPATIBLE w/IOOYo METHANOL O2 STAINLESS STEEL 07.GALVANIZED STEEL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL ❑Unknown <br /> 03.PLASTIC COMPATIBLE W/CONTENTS ❑99. OOEcr 03.PLASTFIBERGLASS <br /> COMPATIBLE W/CONTENTS 09.CA�ODIC PROTECTION O <br /> THER <br /> ❑4.FIBERGLASS �8.FLEXIBLE(HDPE) <br /> [14.FIBERGLASS 0 95 UNKNOWN 465 <br /> 9.CATHODIC PROTECTION 464 ❑5. STEEL W/COATING <br /> 0 5.STEEL W/COATING dull be aabmrtud w n¢lout .) <br /> VII.PIPING LEAK DETECTION e3u=k an mma nAdewei tion of Ne moniwrin r ABOVEGROUND PIPING "] <br /> UNDERGROUND PIPING SINGLE WALL PIPING <br /> SINGLE WALL PIPING <br /> PRESSURIZED PIPING(Ciucka11 t I aPPI Y): <br /> UTO PUMP <br /> PRESSURMEDPIPING(Chackall thataPPIYB 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH D YTS EM <br /> ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT SHUT OFF FOR LEAK,SYSTEM FAILURE,AN DISCONNECTION+ <br /> 1. <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION AUDIBLE AND VISUAL ALARMS. <br /> AUDIBLE AND VISUAL ALARMS. 02. MONTHLY 0.2 GPH TEST <br /> 0 2,MONTHLY 0.2 GPH TEST [13.ANNUAL INTEGRITY TEST(O.IGPH) <br /> 03.ANNUAL INTEGRITY TEST(O.IGPH) 04, DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> CONVENTIONAL SUCTION SYSTEMS <br /> INTEGRITY TEST OF PU <br /> TONING MPING SYSTEM+TRIENNIAL PIPING <br /> 0 S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> S. <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> 07.SELF MONITORING 07, SELF MONITORING <br /> GRAVITY FLOW GRAVITY FLOW(Cheek all my aPPIY): <br /> 0 9.BIENNIAL INTEGRITY TEST(0.1 GPH) 0 8, DAILY VISUAL MONrTORING <br /> 0 9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING <br /> SECONDARILY CONTAINED PIPING PRESSURIZED PIPING tacc)all wt 2"IYL' <br /> PRESSURIZED PIPING(aeck all Out VPIY): 10. CONTINUOUS TURBINE SUMP SENSOR IIB AUDIBLE AND VISUAL <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check ane) <br /> ALARMS AND(Clmck ane) 0 n AUTO PUMP SHUTOFF WHEN A LEAK OCCURS <br /> gja. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM b AUTO PUMP <br /> D SCON'NECTIONT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION ❑c NO AUTO PUMP SHUT OFF <br /> Oc. NO AUTO PUMP SHUT OFF <br /> 1F11. AUTOMATICLINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 011. AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) _ <br /> 0 12, ANNUAL INTEGRITY TEST(GA GPH) SUCTION/GRAVITY SYSTEM <br /> SUCTION/GRAVITY SYSTEM 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY SENSOR <br /> ORS Y D VISUAL <br /> ALA <br /> EMERGENCY GENERATORS ONLY(Check ill Rut SHUT <br /> Cl14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> 0 16. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' AUDIBLE AND VISUAL ALARMS <br /> AUDIBLE AND VISUAL ALARMS FLOW <br /> ❑15.-AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> ❑I5. AUTOMATIC <br /> SHUT T OF OR RESTRICT ON DETECTOR(3.0 GPH TEST)WITHOUT <br /> [116.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) [117. DAILY VISUAL CHECK <br /> 017. DAILY VISUAL CHECK <br /> Vl[I.DISPENSER CONTAINMENT <br /> ❑4.DAILY VISUAL CHECK <br /> DISPENSERCONTAINMENT 0 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE <br /> DATE INSTALLED M11 � UAL ALARMS ❑S.TRENCH LINER/MONITORING <br /> 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VIS <br /> 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> IcenifY that ftinfommtionPwvided hese'^istrve aad acanuwtEc bast-f-1 kwwledge. PATE Oro <br /> SIGNATUREOFOWNE OPE OR 0 4Tx <br /> 471 TITLE OF OWNEROPERAT <br /> NAME OF OWNER/OP (print) a <br /> 475 <br /> Pemut Number(Fm locil ux onlY) 4]3 <br /> mtit ApPwvN(Forlocal use only) /374 Pmrvt Faphatian Dale(Fas kxil use nnlY) <br /> 12 Formerly SWRCB Form B <br /> UPCF(12/99 revised) ' <br />