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UNIFIED PROGRAM CONSOLIDATED FORM TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 Pape-of <br /> VI.PIPING CONSTRUCTION Check411h-- 1) ABOVEGROUND PIPING <br /> UNDERGROUND PIPING ❑7.GRAVITY 459 <br /> 95.lINKNOWN a62 <br /> SYSTEM TYPE 1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 438 [I 1.PRESSURE ❑2. SUCTIO <br /> SINGLE WALL U <br /> CONSTRUCTION ❑1.SINGLE WALL 03.LINED TRENCH ❑99.OTHER 46o O4.TLE WALL 099.OTHER <br /> MANUFACTURER 2.DOUBLE WALL 095.UNKNOWN 461 h1ANUFACTURER <br /> MANUFACTURER ❑6.FRP COMPATIBLE WIIOOS M1rETWsNOL <br /> I.BARE STEEL 0 6.FRP COMPATIBLE W/100% METHANOL O 2.ARE SCEEL S STEEL O 7.GALVANIZED STEEL <br /> ❑2.STAINLESS STEEL O wn <br /> 7.GALVANIZED STEEL 0 UnknoFLEXIBLE <br /> ❑99. Other 0 3. PLASTIC COMPATIBLE W/CONTENTS 0 S.CATHODIC PROTECTION N <br /> 0 3.PLASTIC COMPATIBLE W1 CONTENTS �4.FIBERGLASS 0 9.CATHODIC PROTECTION <br /> �S.FLEXIBLE(HDPE) 465 <br /> 0 4.ST ERGLASS �,I O S. STEEL W/COATING 0 9S.UNKNOWN <br /> ❑5.STEEL W/COATING 9.CATHODIC PROTECTION a ABOVEGROUND PIPING <br /> ha116e auMnirbdb <br /> VIL PIPING LEAK DETECTION Check an mau Il Adexri 6anortne monitorin 67 <br /> UNDERGROUND PIPING SINGLE WALL PIPING <br /> SINGLE WALL PIPING - <br /> PRESSURIZEDPIPING(CheckallWtVP1Yy <br /> PRESSURIZED PIPING(Check all tnat WPIy)' 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> ❑ <br /> I.ELECTRONIC LME LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT O AUDIBLE AND VISUAL ALARMS. <br /> OFF FOR LEAK SYSTEM FAILURE.AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTIO + <br /> AUDIBLE AND VISUAL ALARMS. 0 2. MONTHLY 0.2 GPH TEST <br /> ❑2.MONTHLY 0.2 GPH TEST O 3,ANNUAL INTEGRITY TEST(O.IGPH) <br /> 0 3.ANNUAL INTEGRITY TEST(O.IGPH) [14. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS(nock all wt apply) <br /> CONVENTIONAL SUCTION SYSTEMS <br /> INTEGRITY TEST(ONMONITORING OF PU <br /> I TONMPING SYSTEM+TRIENNIAL PIPING <br /> ❑5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> O 5 <br /> SAFE SUCTION SYSTEMS(NO VALUES M BELO W GROUNDPIPING): O 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> GROUND PIPING): <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW <br /> 07,SELF MONITORING 07. SELF MONITORING <br /> GRAVITY FLOW GRAVITY FLOW(Check all Uat VPIY): <br /> O 9.BIENNIAL INTEGRITY TEST(0.1 GPH) 0 S. DAILY VISUAL MONITORING <br /> [19. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING <br /> SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Chec"110w applY): <br /> PRESSURIZED PIPING(Check dl lb'ePPIY)' 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check«H <br /> ALARMS AND(Check one) 0 P AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> �I a. AUTO PUMP SNUT OFF WHEN A LEAK OCCURSPUMP S14UT <br /> 6 y, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM O b Aurro DISCONNECr10N OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION Oc NO AUTO PUMP SHUT OFF <br /> Oc. NO AUTO PUMP SHUT OFF <br /> IQR(3.0 GPH TEST)WITH FLOW SHUT O II. AUTOMATIC LEAK DETECTOR <br /> 11. AUTOMATIC LINE LEAK DETECTO <br /> OFF OR RESTRICTION O 12, ANNUAL INTEGRITY TEST(0.1 GPH) <br /> O 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM <br /> SUCTION/GRAVITY SYSTEM UOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS O 13.CONTINEMERGENCY GENERATORS ONLY(Check all 0a apply) <br /> EMERGENCY GENERATORS ONLY(neck all Nat apply) O14 CONTINUOUS SUMP SENSOR WITHOUT <br /> AUTO PUMP SHUT OFF• <br /> 0 14.CONTINUOUS SUMP SENSOR WRHOUT AUTO PUMP SHUT OFF' AUDIBLE AND VISUAL ALARMS <br /> AUDIBLE AND VISUAL ALARMS 01S, pUTObfATIC LME LEAK DETECTOR(3.0 GPH TEST) <br /> 0 15 AUTOMATIC <br /> INE LEAK DE ECTOR(3.0 GPH TEST)WITHOUT FLOW <br /> SHUT ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 016 ANNUAL INTEGRITY TEST(0.1 GPH) 017. DAILY VISUAL CHECK <br /> [117. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT Oy DAILY VISUAL CHECK <br /> DISPENSER CONTAINMENT 01.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE <br /> DATE INSTALLED aWl 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS (3 S.TRENCH LINER/MONITORING <br /> 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR [16.NONE <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> aro <br /> I acurY Wt Neinl rmation provided heroin 6 we and accurate no Ne beat army krbwledSe. DATE <br /> SIGNATUREOFOWNER/OI TOR sn <br /> 471 TITLE OF OWNER)OPERATOR \� <br /> NAME OF O E PRA R(pnnQ <br /> v �^ <br /> Permit Appmv (Far local use only) i3tl Pcmtit Eapvation Dere lForl«al ux«ly) <br /> Pemdt Number/F«lod um only) 4D - <br /> Formerly SWRCB Form B <br /> UPCF(12/99 revised) <br /> 12 <br />