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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION check all that I Page_of 2-. UNDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE I.PRESSURE [12.SUCTION 0 3.GRAVITY 458 10 E PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 CONSTRUCTION 0 I.SINGLE WALL 0 3.LINED TRENCH [199.OTHER 460 0 1.SINGLE WALL 0 95.UNKNOWN 462 MANUFACfURER'N 2.DOUBLE WALL 095.UNKNOWN 02.DOUBLE WALL 099.OTHER MANUFACTURER 461 MANUFACTURER 463 01.BARE STEEL 06.FAP COMPATIBLE w/l00% METHANOL 01.BARE STEEL 06.FRP COMPATIBLE W/IN%METHANOL 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 Unknown 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL 0 3.PLASTIC COMPATIBLE W/CONTENTS 0 99. Other 0 3. PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEXIBLE(HDPE) 0 99. OTHER 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) 0 4. FIBERGLASS 0 9.CATHODIC PROTECTION ❑5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING [195.UNKNOWN 465 VIL PIPING LEAK DETECTION(Check all that Adesedtion of the monitoring shall be submitted to the locales UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Checkall that apply): PRESSURIZED PIPING(Check alt that apply): 0 I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST MUTH AUTO PUMP SHUT 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. 0 2.MONTHLY 0.2 GPH TEST [12. MONTHLY0.2 GPH TEST 0 3.ANNUAL INTEGRITY TEST(0.1GPH) 0 3.ANNUAL INTEGRITY TEST(O.IGPH) 04. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑ S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELF MONITORING 0 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Checkall that apply): 0 8. DAILY VISUAL MONITORING 0 9. BIENNIAL GRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING INTE SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all Nm apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Chak one) ALARMS AD(Chock one) 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO SHUT OFF WHEN A LEAK OCCURS 0 It. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION 0c. NO AUTO PUMP SHUT OFF 0c NO AUTO PUMP SHUT OFF �11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 011 AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION 12. ANNUAL INTEGRITY TEST(0.1 GPH) [112. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that appy) EMERGENCY GENERATORS ONLY(Check all that apply) 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF• [114. CONTINUOUS SUMP SENSOR WITHODT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW [:115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) 0 17. DAILY VISUAL CHECK [117. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 0 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK DATE INSTALLED 468 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 5.TRENCH LINER/MONITORING 0 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE Ic mauhc information pmvid in is trve and eccuram to the honey no,knowledge. GN RE OF OTOR DATE 470 CJ�L AME OF - OWNER/ T R(print) 471 TLE OF OWNER/OPERATOR 472 r1- e y, n Mu)OA Parrott Number(Forlocal use only) 473 Pannh Apprmxd(Forlocaleseonly) 474 Pemit Expiration Date Iocal (nly) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form B