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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION Chcck all mat apply) P.,2-.f i UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE O 1.PRESSURE r1p2.SUCTION O 3.GRAVITY 458 ❑1.PRESSURE O 2. SUCTION O 3.GRAVITY 459 mNSIRuCnoN O 1.SINGLE WALL O 3.LINED TRENCH [199.OTHER 460 ❑1.SINGLE WALL [195.UNKNOWN 462 MANIIFAC R 192,DOUBLE WALL 0 95.UNKNOWN O 2.DOUBLE WALL 0 99.OTHER MANUFACTURER 461 MANUFACTURER 463 O 1.BARE STEEL O 6.FRP COMPATIBLE w/IN% MIm1AN01 O 1.BARE STEEL O 6.FRP COMPATIBLE W/Il.METHANOL ❑2.STAINLESS STEEL O 7.GALVANIZED STEEL O UNmown [12. STAINLESS STEEL O 7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS O 99. Other [13. PLASTIC COMPATIBLE W/CONTENTS O 8.FLEXIBLE(HDPE) O 99. OTHER 514.FIBERGLASS O 8.FLEXIBLE(HDPE) [14. FIBERGLASS [19.CATHODIC PROTECTION O 5.STEEL W/COATING O 9.CATHODIC PROTECTION 463 O 5. STEEL W/COATING O 95.UNKNOWN 465 VIL PIPING LEAK DETECTIONCheck all data I (A notion ofttie Monitoring r shall be submitted m the bcd+enc. UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(C k all not apply): PRESSURIZED PIPING(Check all Ilat&,ply): O 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT O 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. [12.MONTHLY 0.2 GPH TEST [12. MONTHLY 0.2 GPH TEST O 3.ANNUAL INTEGRITY TEST(0.IGPR) [13.ANNUAL INTEGRITY TEST(LIGPH) O 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all thm apply) O 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING [15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): O 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) O 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELF MONITORING O 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all tion apply): [18. DAILY VISUAL MONITORING O 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Chxk all that apply): PRESSURIZED PIPING(Cheri all Wet apply): 10. CONTINUOUS TURBINE SUMP SENSOR WIT AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check one) ALARMS AND(Check one) O a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS O a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ I. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM O b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Oc. NO AUTO PUMP SHUT OFF On NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT O 11 AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) O 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS O 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all Ilan apply) EMERGENCY GENERATORS ONLY(CMek atl that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF a [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS O 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION [116.ANNUAL INTEGRITY TEST(0.1 GPH) [116.ANNUAL INTEGRITY TEST(0.1 GPH) O 17. DAILY VISUAL CHECK [117. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE O 4.DAILY VISUAL CHECK DATE INSTALLED 468 O 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS O 5.TRENCH LINER/MONITORING [13.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR IK6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I mr0fy than tM iofomattm pravided Imeein is we and accume to the best ofmy kmwledae. SIGNATURE OF OWNER/OPERATOR DATE OO NAME OF OWNER/OPRATOR(print) 471 1 TITLE OF OWNER/OPERATOR 472 Permit Number(For lanai we only) 473 Permit Approved(For local me only) 474 Permit Expiration Date(For local ate only) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form B