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OIFIED PROGRAM CONSOLIDATED FOR* TANK: TA0506700 PR#: PRO231485 UNDERGROUND STORAGE TANKS -TANK PAGE 2 FAC#: FA0000306 VI.PIPING CONSTRUCTION(Check a0 Wm,Pyly7 UNDERGROUND PIPING Page 7 on ABOVEGROUND PIPING SYSTEM TYPE I.PRESSURE ❑2.SUCTION ❑ 3.GRAVITY 458 ❑ I.PRESSURE ❑2.SUCTION ❑3.GRAVITY 459 CONSTRUCTION ❑L SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 460 ❑ L SINGLE WALL ❑ 95,UNKNOWN MANUFACTURER .DOUBLE WALL ❑95. KNO 1 461 ❑2.DOUBLE WALL ❑ 99.OTHER 062 MANUFACTURER 461 ❑ 1.BARE STEEL ❑ 6.FRP COMPATIBLE w/mol:METHANOL ❑ 1.BARE STEEL ❑6.FRP COMPATIBLE V 100%METHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑PLASTIC COMPATIBLE W/CONTENTS El 95.UNKNOWN ❑PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN ?!t.4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER ❑4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER ❑5.STEEL W/COATING ❑ 9,CATHODIC PROTECTION 464 ❑ 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 465 VII.PIPING LEAK DETECTION(clwx an tht apply)(A d«ription orth moNwri re pngnttt awn h aubmiac9 to We lural agency.) INPIPING SINGLEGLE WALL PIPING ABOVEGROUND PIPING PRESSURIZED PIPING(Check all that apply): 466 SINGLE WALL PIPING PRESSURIZED PIPING(Check all that apply): 467 ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. [32.MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 2.MONTHLY 0.2 GPH TEST ❑3,ANNUAL INTEGRITY TEST(0.1 GPH) ❑4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING ❑5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(No VALUES IN BELOW GROUNDPIPING): ❑6.TRIENNIAL INTEGRITY TEST(0.I GPH) ❑ 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): GRAVITY FLOW ❑ 7.SELF MONITORING ❑ 9.BIENNIAL INTFGRrFY TEST(0.1)GPH GRAVITY FLOW(Check all that apply): ❑ 8.DAILY VISUAL MONITORING ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(C kone) �a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑6.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑6.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ C. NO AUTO PUMP SHUT OFF ❑ c.NO AUTO PUMP SHUT OFF 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(C6ecka11 Wat apply) EMERGENCY GENERATORS ONLY(Click all Wat apply) ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF• ❑ 14,CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF" AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17.DAILY VISUAL CHECK [:1 17.DAILY VISUAL CHECK VILL DISPENSER CONTAINMENT DISPENSER CONTAINMENT �'7 1,FLOAT MECHANISM THAT SRUTS OFF SHEAR VALVE DATE INSTALLED /-k E] 4.DAILY VISUAL CHECK 468 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS Q 7 J ❑ 5.TRENCH LINER/MONITORING o `�1` ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑b.NONE DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE 469 I mlify not the mf adoa pnvlEel herein is puc atd aowaten th best armykmwkalgc SIGNATURE OF OWNER/OPERATOR DATE 490 NAME OF OWNER/OPERATOR(print) TITLE OF OWNER/OPERATOR 4]I n2 Pnmit Number(Forlwal tacaNYJ 473 P.it A,navvM(For 1.1 me only) 474 Pmnit Expiration Date(For l«al use only) 475 PT0000313 EE0000817 6/30/2003 UPCF(12/99 revised) 0