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A1p <br /> AOL <br /> qw <br /> UNIFIED PROGRAM CONSOLIDATED FORNI TANK: TA0160006 <br /> PR H: PRO231600 <br /> • FAC N: FA0000957 <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(chatk yi m.,aWh) N,7d 7 <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE ® I.PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY 458 ❑ L PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY459 <br /> CONSTRUCTION E]I SINGLE WALL ❑3.LINEDTRENCH El 99 OTHER 46M El I.SINGLE WALL El 95 UNKNOWN 462 <br /> M2 DOUBLE WALL 095.UNKNOWN ❑ ZDOUBLE WALL El.OTHER <br /> MANUFACTURER A O SMITH 461 MANUFACTURER 463 <br /> ❑ I.BARE STEEL ❑ 6.FRP COMPATIBLE../1W1.METHANOL ❑ I.BARE STEEL ❑ 6.FRP COMPATIBLE.,/IOM.METHANOL <br /> ❑2.STAINLESS STEEL [17 GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZEDSTEEL <br /> ❑ PLASTIC COMPATIBLEW/CONTENTS ❑ 95.UNKNOWN ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95 UNKNOWN <br /> ® 4.FIBERGLASS ❑ S.FLEXIBLE(HOPE) ❑ 99.OTHER ❑ 4.FIBERGLASS ❑ e.FLEXIBLE(HDPE) ❑ 99.OTHER <br /> ❑5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 4U E] 5.STEEL W'COATING E39.CATHODIC PROTECTION 465 � <br /> VTI.PIPING LEAK DETECTION¢nak au,m,aoplr)L+dssmpiq,arme nh�n.a paw sn.Il x s.6mind,o MK I«.,I.a.,.,., <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING ,1fifi SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Cheek all that apply): PRESSURIZED PIPING(Check ell that apply) <br /> ❑ I.ELECTRONIC LINE LEAK DETECTOR 30 GPH TEST WITH AUTO PUMP SHUT OFF ❑ I ELECTRONIC LINE LEAK DETECTOR 3 0 GPH TEST WITH AUTO PUMP SHUT OFF <br /> FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION,AUDIBLE AND FOR LEAK,SYSTEM FAILURE.AND SYSTEM DISCO"ECTION+AUDIBLE AND <br /> VISUAL ALARMS. VISUAL ALARMS. <br /> ❑2.MONTHLY 0 2 GPH TEST <br /> '- <br /> El 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ MONTHLY 0.2 GPH TEST E] 3 ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ 4.DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that applyy <br /> El 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING ❑ 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) ❑ 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUN DPIPING): SAFE SUCTION SYSTEMS IND VALUES IN BELOW GROUNDPIPING): <br /> [I 7.SELF MONITORING Ill <br /> f-] 7.SELFMONITORING <br /> GRAVITY FLOW <br /> ❑ 9.BIENNIAL INTEGRITY TEST(0 1)GPH GRAVITY FLOW(Cheek all that apply): <br /> ❑ S,DAILY VISUAL MONITORING <br /> ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Chak all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBME SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check mel ALARMS AND IChal:an, <br /> M a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> ® b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b.AUTO PUMP SHUTOFF FOR LEAKS.SYSTEM FAILURF..AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> ❑ c. NO AUTO PUMP SHUT OFF ❑c. NO AUTO PUMP SHUT OFF <br /> (91 11.AUTOMATIC LME LEAK DETECTOR(3.0 GPH TESTI WITH FLOW SHUT OFF OR ❑ <br /> RESTRICTION I I AUTOMATIC LEAK DETECTOR <br /> ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST 10.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRA VITY SYSTEM <br /> ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Chak A,/,apply) EMERGENCY GENERATORS ONLY(Chx all Na epph9 <br /> ❑ 14.CONTINUOUS SUMP SENSOR WRHOL'T AUTO PUMPSHUT OFF• ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMPSHUTOFF• <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> ❑ 15.AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ 15.AUTOMATIC LME LEAK DETECTOR(3 0 GPH TEST)WITHOUT FLOW <br /> SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION <br /> ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ <br /> 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK <br /> VIIL DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT ❑ I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4.DAILY VISUAL CHECK <br /> DATE INSTALLED <br /> 46e ® '_.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING <br /> ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑ 6.NONE <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS 469 <br /> D(.OWNER/OPERATOR SIGNATURE <br /> Imtifi Bu„he ufamaion ptmidedbeinu vuc vd auum,e,o Je bas knoxiMyc. <br /> SIGNATURE OF OWNER/OPERATOR DATE `_�f 470 <br /> NAME OF OWNERIOPERATOR(pnnt) TITLE OF OWNE OPERATOR v <br /> JARNAIL S KAMBOJ J71 PRESIDENT J12 <br /> Permit Numbs(Fa locU uxmhl 473 Pani,Appmred lFa lyd uK mhl 474 Pmmi,Expim,im Dma(Fw boil uaa mh) 475 <br /> PT0004281 EE0000646 12/31/1993 12:00:OOAM <br /> UPCF(12/99 revised) <br />