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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(GMck atl VNl appy) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1 PRESSURE • ❑ 2. SUCTION ❑ ] GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ ]. GRAVITY CONSTRUCTIOW ❑ 1..SINGLE WALL 11 ]. LINED TRENCH 1199 OTHER ❑ 1, SINGLE WALL ❑95. UNKNOWN , MANUFACTURER �] DOUBLE WALL 1195, UNKNOWN Z. DOUBLE WALL 1199. OTHER MANUFACTURER j MANUFACTURER ❑ 1.BARE STEEL ❑ 8. FRP COMPATIBLE Wr 100%METHANOL ❑ 1. BARE STEEL ❑ e. FRP COMPATIBLE WI 100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL CORROSION ❑ T.GALVANIZED STEEL PROTECTION ❑). PLASTIC COMPATIBLE KITH CONTENTS 0 9 UNKNOWN ❑ 0, PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXIBLE(HOPE) ❑99. OTHER Cp C FIBERGLASS ❑ k FLEXIBLE(HDPE) ❑99. OTHER. ❑ 4. FIBERGLASS ❑ 9, CATHODIC PROTECTION ❑ 5. STEEL W,COATING ,. CATHODIC PROTECTION Cl 5. STEEL W1 COATING 095. UNKNOWN VII.PIPING LEAK DETECTION(Chaeka8thatwm - SINGLE WALL PIPING UNDERGROUND PIPING ABOVEGROUND PIPING PRESSURIZED PIPING(Chock am that apply): SINGLE WALL PIPING PRESSURIZED PIPING(Check aNal appM; ❑ 1. ELECTRONIC LINE LEAK DETECTOR 0.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILUR E.AND SYSTEM OISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL ALARMS Al-ARIAS ❑ 2. MONTHLY02 GPHTEST ❑ Z. MONTHLY 0,2 GPM TEST ❑ ].ANNUAL INTEGRITY TEST(01 GPM) ❑ ].ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUMON SYSTEMS(Check all Nat appy): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPINGSYSTEM TEST IB IGPM) ❑ 8. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' ❑ T. SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Chock all that appMr ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GRH) ❑ B DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(01 GPM) SECONDARILY CONTAINED NG PRESSURIZED PIPNG(Chock) that applK: PRESSURIZED PIPING SECONDARILY CONTAINED PIPING (Chock as Ilial apply): 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUALALARMS AND tCee a) 10.CONTINUOUS TURBINE SUMP SENSOR WATH AUDIBLE AND VISUAL ALARMS ANO(check ono) VUTO PUMP SHUT OFF WHEN A LEAK OCCURS 11a.AUTO PUMP SMUT OFF WHEN A LEAK OCCURS AUTO PUMP SMUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ B. AUTO PUMP SMUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION �1�❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF Way 1. AUTOMATIC LINE LEAK DETECTOR(]0 GPMRESTRICTION TEST)WITH FLOW SHUT OFF OR 11W,V11 AUTOMATIC LEAK DETECTOR ANNUAL INTEGRITY TEST 111 I GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIO WORAVITY SYSTEMSUCTIONrORAVITY SYSTEM: 10 CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13 CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chack all Mat apply) EMERGENCY GENERATORS ONLY(Crack all that apply) 14.CONTINUOUS SUMP SENSOR VITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUALALARMS ALARMS 15. AUTOMATIC ONE LEAK DETECTOR(0.0 GPM TEST)W^THOUT FLOW SMUT OFF OR 1115,AUTOMATIC UNE LEAK DETECTOR(00 GPM TEST) RESTRICTION 18.ANNUAL INTEGRITY TEST(0.1 GPM) 1318. ANNUAL INTEGRITY TEST(0.1 GPM) 1T. DAILY VISUAL CHECK ❑ IT. DAILYVISUALCMECK YID.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 1. FLOAT MECHANISM THAT SMUTS OFF SMEAR VALVE ❑ 4. DAILY VISUAL CHECK ATEINS ;ED ❑�YCONTINVOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS C15. TRENCH LINER/MONITORING �].CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ S. NONE IX OWNERJOPERATOR SIGNATURE 1 MrMY Nal Na mfQ=ab0n PMW6d hnovIl1 IS INa NE aC4lfala b Na Ga10t TY knp'MaG9a. SIGNATURE OF OWNERIOPERATOR DATE /P NAME OF WRPO / �• D IEOFOVWPETOR " ^^� � panni)Numaar(Falooll...rpyJ Pantit AppmvaA(FPrlpul ms wVy) Jr �`•- l PamN 6p'vaYpnD Fprlacal uas poly) Do CUPAFORM(4199) Formerly S'NRCB Form 8