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I UNIFIED PROGRAM CONSOLIDA TEDFORIA ( n7�Og IcL n TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 �" VL PIPING CONSTRUCTION(OMckep NahpplyJ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE I PRESSURE ❑ 2. SUCTION ❑ ]. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ ].GRAVITY CONSTRUCTION/ ❑ 1 INGLE WALL ❑ ]. LINED TRENCH ❑99 OTHER ❑ 1. SINGLE WALL 1195. UNKNOWN MANUFACTURER DOUBLE WALL ❑95. UNKNOWN I__n/ % ❑ 2. DOUBLE WALL ❑99. UNKN MANUFACTURER )Pel wa�/yF/��J-J MANUFACTURER ❑ HER I BARE STEEL ❑ B. FRPCOMPATIBLEWI100%METHANOL ❑ 1. BARE STEEL ❑ e,FRP COMPATIBLE WI 100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL CORROSION - ❑ 7.GALVANIZED STEEL PROTECTION C❑ ] PLASTIC COMPATIBLE WITH CONTENTS ❑95 UNKNOWN ❑ ]. PLASTIC COMPATIBLE WITH CONTENTS ❑ a. FLE LISLE(HOPE/ ❑99. OTHER ff FIBERGLASS ❑ S. FLEXIBLE(HOPE) ❑90. OTHER. ❑ e. FIBERGLASS ❑ 9, CATHODIC PROTECTION ❑ 5 STEEL WICOATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEELWICCATING ❑95. UNKNOWN VIL PIPING LEAK DETECTION(Check N Mat appy) ' UNDERGROUND PIPING ABOVEGROUND PIPING TINGLE WALL PIPING PRESSURIZED PIPING(CArtk ep 0v apply): SINGLE WALL PIPING PRESSURIZED PIPING([hack ep Naf eypy): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST KITH AUTO PUMP SHUT OFF FOR LEAK, LEAK.SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL ALARMS ALARMS ONTHL ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2.ANNUAL NNUAL INTEGRIPM TY TESEST ❑ ].ANNUAL INTEGRITY TEST RLI GPM) ❑ ]. ANNUALINTEGWTY TEST(O1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(CMck ap that appy): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST ID I GPM) ❑ B. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' ❑ I SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW ❑ GRAVITY FLOW([Arch ad that appy)9 BIENNIAL INTEGRITY TEST 101GPH1 ❑ B. DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(0.I GPH/ SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING fCnxk sp Nat apply)' PRESSURIZED PIPING(Chock ea Nat appyy 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUA L ALARMS AND inom anal 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(crack One) C/AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ e.AUTO PUMP SHUT OFF MEN A LEAK OCCURS tl 0 AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ G. AUTO PUMP SHUTOFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION R<1 C1c NOAUTO PUMP SMUT OFF ❑ c NOAUTO PUMP SHUT OFF R<1. AUTOMATIC LINE LEAK DETECTOR(3.O GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATICLEAKOETECTOR M 4 RESTRICTION LW 12 ANNUAL INTEGRITY TEST IO 1 GPM) Cl 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCCTION.fiRAVITY SYSTEM SUCTIOWGRAVITY SYSTEM , : 1] CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 13 CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Crack J Nat appy) EMERGENCY GENERATORS ONLY(Chwk ad Naf appy) L�l1a. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF a AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF a AUDIBLE AND VISUAL VISUALALARMS ALARMS 15. AUTOMATIC LINE LEAK DETECTOR(].0 GPM TEST)W TROUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC UNE LEAN DETECTOR(3.0 GPM TEST) ARES RICTION LS 1B.ANNUAL INTEGRITY TEST IDA GPM) ❑ 16. ANNUAL INTEGRIW TEST(0.1 GPM) ❑ 17, DMLYVISUALCHECN ❑ 17. DAILYMSUALCHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT Pl. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. OAILYVISVALCHECK TE ST LLEO ❑ 2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 3. TRENCH LINER/MONITORING 10 ]. CONTINUOUS DISPENSER PAN SENSOR WTH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑ B. NONE 44=111A/Ir OWNERIOPERATOR SIGNATURE I wNy m Na I IQr 0IWM FaMi0eB hmin N We incl aciapate b IM Gast of my McMladga. SIGNATURE OF OVMEFLOPERATOR DATE NAME OF OWIEW'OPERATOR rynrq212 L �_ TITLE Of OWN/OERIOM pETOR�� r oc9 � C Pumil NvmSaA(Fabpal vae oMy/ Pemst Appmve0(FOYrowl uae only) Pamt4 Ekplawn ate(FwlO "aaNy) rood .r yr CUPAFORM(4/99) Formerly SWRCS Form 6