Laserfiche WebLink
U VOW <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 TANKS <br /> VL PIPING CONSTRUCTION Checkml meta I Pagej�ofZ <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE X 1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 458 0 1.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 <br /> CONSTRUCTION 0 1.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 0 1,SINGLE WALL 0 95.UNKNOWN 462 <br /> MANUFACNRER 0 2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER 461 MANUFACTURER 463 <br /> 0 1.BARE STEEL 0 6.FRP COMPATIBLE w/IoOY. METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE W/1(ft.METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 Unlalown 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPATIBLE W/CONTENTS 0 99. Other 0 3. PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEXIBLE(HDPE) 0 99. OTHER <br /> JK4.FIBERGLASS 0 8.FLEXIBLE(HDPE) 0 4. FIBERGLASS <br /> (]9.CATHODIC PROTECTION <br /> 0 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING 0 95.UNKNOWN 465 <br /> VR.PIPING LEAK DETECTION Clnolt all mal 1 A deacri don offt noonitorina Emutan gnall be submitted w me weal a anc. <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING((1heck all thn appy): PRESSURIZED PIPING(Check all mat apply): <br /> ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LE 1,AND SYSTEM <br /> AUTO PUMP <br /> AK,SYSTEM FAILUREDISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> ❑2.MONTHLY 0.2 GPH TEST 0 2. MONTHLY 0.2 GPH TEST <br /> 0 3.ANNUAL INTEGRITY TEST(O.IGPI) 0 3.ANNUAL INTEGRITY TEST(O.IGPE) <br /> 0 4. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all mat apply) <br /> 0 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING <br /> [3INTEGRITY TEST(0.1 GPH) 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPI) <br /> [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELF MONITORING <br /> 0 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Checkau met apply): <br /> 0 8. DAILY VISUAL MONITORING <br /> 0 9. BIENNIAL INTEGRITY TEST(O.l GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all Nat apply): PRESSURIZED PIPING(Check all mu apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check oro) ALARMS AND(Chink one) <br /> [3a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> Pqc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF <br /> ❑11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) 4l r H FLOW SHUT 0 11 AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> 12. ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. ANNUAL INTEGRITY TEST(0.1 GPI) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 0 13. CONTINUOUS SUMP SENSOR,AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all Nat apply) EMERGENCY GENERATORS ONLY(C all that apply) <br /> 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> [116.ANNUAL INTEGRITY TEST(0.1 GPI) [116.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 0 17. DAILY VISUAL CHECK 0 17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT [11.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 X 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 5.TRENCH LINER/MONITORING <br /> 0 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> I ar4y met dw iMmrnadov provided heroin is nuc and aecmate to me ben ofmy kaowlalge. <br /> SIGNATURE OF OWNER/OPERATOR DATE 470 <br /> NAME OF OWNER/OPRATOR(print) 471 1 TITLE OF OWNER/OPERATOR 472 <br /> Pm Lt Noon c (Fmlmalmeoaly) 473 Perout Approved(For local-only) 474 Pemnt Expiration Dote(For local use only) 475 <br /> UPCF(12/99 revised) 12 Formerly SWRCB Form B <br />