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AOL 0mw 0 11 UNIFIED PROGRAM CONSOLIDATED FORM TANK: TA0160005 b _ PR q: PRD271600 UNDERGROUND STORAGE TANKS - TANK PAGE 2 FAC a: FAO0110957 VL PIPING CONSTRUCTRUN(Ch kall8m apple) Pagejun UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ® 1.PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY 438 ❑ 1.PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY 459 CONSTRUCTION ❑1.SINGLE WALL ❑3.LINED TRENCH ❑ 99.OTHER u9 ❑ L SINGLE WALL2.DOUBLE WALL ❑ 95_UNKNOWN 4(E MANUFACTURER® A O SMITH ❑95 UNKNOWN u1 El 2,DOUBLE WALL El 99 OTHER MANUFACTURER 463 ❑ LBARE STEEL ❑ 6.FRP COMPATIBLEw l0 '-METHANOL 0BARE STEEL ❑6.FRPCOMPATIBLE o'100.METHANOL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ PLASTIC COMPATIBLE W/CONTENTS 0 9.UNKNOWN ❑ PLASTIC COMPATIBLEW/CONTENTS ❑ 95.UNKNOWN ®4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER ❑4.FlBERGLASS ❑ S.FLEXIBLE(HDPE) ❑99.OTHER ❑ 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 4W ❑ 5.STEEL W/COATING ❑9 CATHODIC PROTECTION 40VII.PIP(N LEAK DETECTIONIChak all0a)apph)IA aacriptian arNemml:ann pmgam shall l suhmutW w melaal a aa..i UNDERGROUND PIPING ABOVEGROUND PIPINGSINGLE WALL PIPING SINGLE WA PRESSURIZED PIPING(Check all that apply): LL PIPING -- 0PIPING(Check all that apply): 467 ❑ L P,LEAK.SYSTEM LINFAIL K E,DETECTOR TEM DI TEST WITH AUTO PUMP SXL?OFF ❑ I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FORA AILARMS. FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND FOR LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. N❑-s '_.MONTHLY 0.2 GPH TEST u 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 2.MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑ 5.DAILY VISUAL MONITORINGOFPUMPINGSYSTE.M-TRIENNIEAL PIPING C] 5,DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM. INTEGRITY TEST(0 1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑ 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑ 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): GRAVITY FLOW ❑ 7.SELF MONITORING ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH GRAVITY FLOW(Cheek all that apply): ❑ 8.DAILY VISUAL MONITORING ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Clink arc) ALARMS AND IChad ca) ®e.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF I L AUTOMATIC LINE LEAK DETECTOR 0.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12_ANNUAL INTEGRITY TEST 10.1 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(Clerk all m.:apph) EMERGENCY GENERATORS ONLY(Chak all Wa.pply) ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF• ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMPSHU''TOFF• AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑SHUTOFF RAUTOMATIC LINE LEAK TION DETECTOR CIO GPH TEST)WITHOUT FLOW ❑ 15.AUTOMATIC LINE LEAK DETECTOR Ll 0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(O.l GPH) ❑ 16.ANNUAL INTEGRITY TEST 10.1 GPH) ❑ 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK VIIL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INSTALLED ❑4.DAILY VISUAL CHECK ® 2.CONTINUOUS DISPENSER PAN SENSOR AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING C1 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 6.NONE DISPENSER AUDIBLE AND VISUAL ALARMS ,)y9 LC OWNER/OPERATOR SIGNATURE I mkF tha Ua iManeakmpmided hpmin is OuaaM to Je fins-kmi SIGNATURE OF OWNER/OPERATOR DATE 470 NAME OF OWNERIOPERATOR(print) TITLE OF OWNER/OPERATOR JARNAIL S KAMBOJ J11 PRESIDENT 472 Perm'Numha(Fa kcal uu M,j 473 Pani:ApprmN(Fa kcal use mhl 474 P. 1 Ecp.1.Date(Fa local uamh) 475 PT0004281 EE0000646 12/31/1993 12:00:OOAM UPCF(12/99 revised)