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� r . UNIFIED PROGRAM CONSOLIDATED FORM TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 Page-of VL PIPING eitelEtltBtapPly', UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 0 1.PRESSURE ❑2.SUCTION D 3 GRAVITY 458 D 1.PRESSURE ❑2. SUCTION D 3.GRAVITY 458 CONSTRUCTION 1 ❑1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 460 ❑1.SINGLE WALL ❑95.UNKNOWN 462 MANUFACTURER ®2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER TOtal COrltalnement 461 MANUFACTURER 4ss ❑1.BARE STEEL D 6.FRP COMPATIBLE W1100% METHANOL --El.BARE STEEL ❑6.FRP COMPATIBLE W1100%METHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑UKNOWN ❑2. STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W1 CONTENTS [199. OTHER ❑.3. PLASTIC COMPATIBLE W1 CONTENTS ❑B.FLEXIBLE(HDPE) E3 99, OTHER 0 4 FIBERGLASS 0 8.FLEXIBLE(HDPE) [14. FIBERGLASS ❑9.CATHODIC PROTECTION D 5 STEEL WICOATING ❑9 CATHODIC PROTECTION 464 ❑5 STEEL WICOATING ❑95 UNKNOWN 465 ITI 4?f 3ttBfi?�4,.: m st ae is)s giibtxu#GeikBrt .' aq UNDERGROUND PIPING PIPING SINGLE WALL PIPING 4e8 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check al[hat apply): PRESSURIZED PIPING(Check all that apply)' ELECTRONIC LINE LEAK ❑1 LEAK,SYSTELECTRONEC LINE LEAK M FAILURE,ANDECTOR 3.0 GPH TEST WITH SYSTEM DISCONNECTION/+AUDIBLE AND VISUAL UTO PUMP SHUT OFF FDR ❑1 LEAK,SYSTEM FAILURE,ANDECTOR 3,0 GPH TEST WITH SYSEM DISCONNECTION+AUDIBLE AND VISUAL PUMP SHUT OFF OR ALARMS. ALARMS. D Z MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST ❑3. ANNUAL INTEGRITY TEST(0.1GPH) ❑3. ANNUAL INTEGRITY TEST(0.1GPH) D4. DAILY VIS UAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) E15. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY [16. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNPIPING): ❑6. TRIENNIAL INTEGRITY EST(0.1 GPH) ❑7 SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING); GRAVITY FLOW ❑7. SELF MONITORING ❑9. BIENNIAL INTEGRITY 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 10. N INUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check ane) Ela. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Rb, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUT DISCONNECTION SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF ®11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR ❑it AUTOMATIC LEAK DETECTOR RESTRICTION 19 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12, ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUni ONIGRAVITY SYSTEM ❑13, CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF*AUDIBLE AND ❑14. VISUAL CONTINUOUS ALARMS MP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ALARMS 0 15, AUTOMATIC LINE LEAK DETECTOR(3 D GPH TEST)WITH FLOW SHUT OFF OR ❑15 AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION 16, ANNUAL INTEGRITY TEST(D.1 GPH) ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑17 DAILY VISUAL CHECK [117. DAILY VISUAL CHECK 17 DISPENSER ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14,DAILY VISUAL CHECK CONTAINMENT DATE INSTALLED 468 0 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS El 5.TRENCH LINER 1 MONITORING ISI 3. CONTI US DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ CI 6,NONE 469 1998 AUDI E NDVISUALALARMS I certify that the information provided herein is tru an ace to th Lest of my knowledge. SIGNATURE OF OWNERIOPERATO =DATE 470 NAME OF OWNERIOPRATOR(print) TITLE OF LI)WEI/;OPERATOR 472 Bob DeNinno Environmental Manager Permit Number(For local use only) 473 Permit Approved(For local use only) Permit Expiration Date(For local use only) 475