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U FIED PROGRAM CONSOLIDATED FORI'lil TANK UNDERGROUND STORAGE TANKS TANK PAGE 2 Page _ of VI.PIPING . RSTRUIP.-n (Ch UNDERGROUND PIPING ABOVEGROUND PIPING ass SYSTEM TYPE 0 1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 458 ❑1.PRESSURE ❑2. SUCTION❑95.UNKNOWN 3.GRAVITY 462 CONSTRUCTION 1 ❑1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 460 ❑1.SINGLE WALL [199.OTHER MANUFACTURER 2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL est MANUFACTURER 463 MANUFACTURER TOtaI Containment ❑1.BARE STEEL ❑6 FRP CO wnoaMEr METHANOL 1.BARE STEEL ❑6.FRP COMPATIBLE w11001A kETHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑UKNOWN ❑2. STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS [199, OTHER ❑3. PLASTIC COMPATIBLE W!CONTENTS 0 9.CATHIODIG PROTECTBLE(HDPE) ION OTHER ®4.FIBERGLASS ®B.FLEXIBLE(HDPE) [14. FIBERGLASS [15.STEEL WICOATMG ❑9.CATHODIC PROTECTION 48a [3 5 STEEL WICOATING [195.UNKNOWN 4 1£ pggiabmits7ct'ttiFig. t,'ar;c ) ::.:: ... II..P M r +'ITY {JI lase..�4t4f I !FIOr?I�pF.` ABOVEGROUND PIPING UNDERGROUND PIPING SINGLE WALL PIPING 467 SINGLE WALL PIPING aas PRESSURIZED PIPING(Check as the apply): LIMP SHUTPRESSURIZED PIPING{Check all that apply): ❑ 1, ELECTRONIC LINE LEAK LEAK,SYSTEM FAILURE.AN DETECTOR SYS EM DISCONNECTION AUTO BLE AND VISUAL OFF FOR ❑1 LEAK,SYSTIEMIFAIL RE,AND SYSTEM SCONNECTION,AUDIB ENE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PA DUVISUAL DR ALARMS. ALARMS ❑2. MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST [13. ANNUAL INTEGRITY TEST(0.1GPH) ❑3. ANNUAL INTEGRITY TEST(0.1GPH} ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY [15, DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) [36. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING), [17 SELF MONITORING ❑7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Cheek all that apply): [19, BIENNIAL INTEGRITY TES(0.1 GPH) ❑8. DAILY VISUAL MONITORING [39. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Cheek all apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR W ITH AUDIBLE AND VISUAL ALARMS AN (Check one) (Check one) ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM (2R b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AN 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 SHUTOFF OR (]11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) ®12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONIGRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AN VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) GENERATORS ONLY(Check all that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑14. VON ANULUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AN VISUAL ALARMS ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR ❑15_ AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION ❑16, ANNUAL INTEGRITY TEST(0.1 GPH) ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) [:117. DAILY VISUAL CHECK ❑17 DAILY VISUAL CHECK Vlil.i]ISPEN ER CONTAINMENT ---- DISPENSER - ❑4.DAILY VISUAL CHECK ❑1 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE CONTAINMENT 5.TRENCH LINER 1 MONITORING DATE INSTALLED 488 ❑2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ ❑6 NONE ass 1998 AUDIBLE AND VISUAL ALARMS I certify that the information provide h sin, true and'accurate to the best of my knowledge. 470 SIGNATURE OF OWNER/O DATE -1- ) N 472 NAME OF OWNERIOP OR(print) TITLE OF OWN RIOPERATOR Bob DeNinno Environmental Manager Permit Expiration Date(For local use only) Permit Number(For local use onty) 473 Permit Approved(Far local use only) 475