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^ ��UNIFIED PROGRAM CONSOLIDATED FOR I �( TANK: TA0506224 �1 � V PR 8: PR0506221 UNDERGROUND STORAGE TANK FAC B: FA0007287 - T PA E 2 VI.PIPING CONSTRUCTION(cl alitItit apply) p�7of7 UNDERGROUND PIPING VEGROUND PIPING SYSTEMTYPE (.PRESSURE [12.SUCTION ❑3.GRAVITY 458 ❑ I.PRESSURE [12.SUCTION ❑},GRAVITY 459 CONSTRUCTR)N\ ❑1.SINGLE WALL 03.LINED TRENCH [199.OTHER 460 ❑ 1.SINGLE WALL [195.UNKNOWN 4fi2 J DOUBLEWALL 095.UNKNOWN El 2.DOUBLE WALL 099.OTHER MANUFACTURER 461 MANUFACTURER 463 ❑ I.BARE STEEL ❑6.FRP COMPATIBLE.r 1a METHANOL ❑ 1.BARE STEEL ❑ 6.FRP COMPATIBLE w 190X METHANOL ❑2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN ❑ PLASTIC COMPATIBLE W/CONTENTS ❑95.UNKNOWN 4.FHH RGLASS ❑8.FLEXIBLE(HDPE) ❑ 99.OTHER ❑4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑MOTHER 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 464 ❑5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 465 VII,PIPING LEAK DETECTION(ceaaa r6u apply)(A emmimian ofaemmmt gpm sWI 6ea6autmllo se laml,su y.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING asb SINGLE WALL PIPING m7 PRESSURIZED PIPING(Cheek all that apply): PRESSURIZED PIPING(Chcok all that apply): ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ 1.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. ❑2.MONTHLY 0.2 GPH TEST ❑ 2,MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Cheek all that apply) ❑ S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING ❑5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) ❑6.TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑ 7.SELF MONITORING 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(Chak all that apply): PRESSURIZED PIPING(Cheek all that apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMSAND(cha ) ALARMSAND(Eberhaee) ❑.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS "Kb.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION 1 ❑c.NO AUTO PUMP SHUT OFF ❑c. NO AUTO PUMP SHUT OFF 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST I Wo 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(C all Out epply) EMERGENCY GENERATORS ONLY(CI ktllw apply) ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF e ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ I5.AUTOMATIC LME LEAK DETECTOR(}.0 GPH TEST)WITHOUT FLOW ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW IsRUT 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 ❑ 17.DAILY VISUAL CHECK V IR.DISPENSER CONTAINMENT DISPENSER CONTAINMENT \ ❑ L FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4.DAILY VISUAL CHECK DATEINSTALLED a68 1 `1�0 CONTINUOUS DISPENSER PAN SENSOR AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LIVER/MONITORING ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑ 6.NONE DISPENSER+AUDIBLE AND VISUAL ALARMS 469 IX.OWNER/OPERATOR SIGNATURE I fy tW the infmmuim pmvNN 6min o mend 4o-wae to a.best ofmykno.ledlle. SIGNATURE OF OWNER/OPERATOR DATE 470 NAME OF OWNEWOPERATOR(pant) TITLE OF OW NER/OPERATOR 471 472 Ppmi�NwbvfFm loeY uuadY) 473 Pmmil Appm (Fceloealmeay) 474 Permit Expimtion Wtc(Fm lmd use-4y) 475 PT0008688 EE0000817 12/31/2008 12:00:OOAM UPCF(12/99 revised)