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i UNII,E D PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS -TANK PAGE 2 TANKS VI.PIPING CONSTRUCTION ch<eka0 the I page_of_ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1.PRESSURE D 2.SUCTION D 3.GRAVITY 458 ❑1.PRESSURE ❑2. SUCTION CONSTRllCT10N D 1.SINGLE WALL D 3.LINED TRENCH ❑3.GRAVITY 459 ❑99.OTHER 460 ❑I.SINGLE WALL ❑95.UNKNOWN 462 MANUFACTURER Q�2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL MANUFACTURER ❑99.OTHER 461 MANUFACTURER 463 ❑1.BARB STEEL 6.FRP COMPATIBLE w/100% N4ETEIANOL ❑1.HARE STEEL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑6.FRP COMPATIBLE W/l00%I,mTF1ANOL ❑Unknown ❑2. BE STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS D 99. Other D 3. PLASTIC COMPATIBLE W/CONTENTS 118-FLEX®LE FLEXIBLE(HDPE) ❑99. OTHER D 4.FIBERGLASS D 8.FLEXIBLE(HDPE) ❑4, FIBERGLASS D 5.STEEL W/COATING 119.CATHODIC PROTECTION 464 119.CATHODIC PROTECTION ❑5. STEEL W/COATING ❑95.UNKNOWN 465 VII.PIPING LEAK DE IECF ON Check all that 1 Adeaai donathe im.hom"romo shell be submitted to the bml me. UNDERGROUND PIPING PIP]NG SINGLE WALL PIPING ABOVEGROUND 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Checka0 thatapply): �rrrmr�Mya PRESSURIZED PIPING(Chmkall that applyk ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST y. AUTO POMP SH UT ❑1. ELECCR0 CLINE LEAKD6IECTOR3.0 GPHTESC}yI¢T AUTOPUMP OFF FOR LEAK,SYSTEM FAILURE,ANp SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS, AUDIBLE AND VISUAL ALARMS. ❑2.MONTHLY 02 GPH TEST D 2.MONTHLY 02 OPH TEST D 3.ANNUAL INTEGRITY TEST(O.1GPH) D 3.ANNUAL INTEGRITY TEST(O.IGPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Ch.&all dot apply) [15.DAII,Y VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) D 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): D 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) D 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELF MONITORING D 9.BIENNIAL INTEGRITY TEST(0.1 GpH) GRAVITY FLOW(Cl kali that apply): [18. DAILY VISUAL MONITORING D 9.BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all tatapplyY PRESSURIZED PIPING(Quick all tlutapply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check ova) ALARMS AND(Checkam) I a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS D a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM D b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTIONDc.NO AUTO PUMP SHUT OFF De NO AUTO PUMP SHUT OFF 1XII. AUTOMATICLINE LEAK DETECTOR(3.0 OPH TEST)MM FLOW SHUT OFF OR RESTRICTION ❑11. AUTOMATICLEAKDETECTOR QQ 12. ANNUAL INTEGRrrY TEST(0.1 GPH) D 12. ANNUAL INTEGRITY TEST(O.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM D 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS D 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) [114. CONTINUOUS SUMP SENSOR wrlTlouT AUTO PUMP SHUT OFF• AUDIBLE AND VISUAL ALARMS D 14. CONTINUOUS SUMP SENSORT AUTO PUMP SHUT OFF❑ AUDIBLE AND VISUAL ALARMS I5. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WTTHOIIT PLOW SHUT OFF OR RESTRICTION D 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) D 16.ANNUAL INTEGRITY TEST(0.1 GPH) [116.ANNUAL INTEGRITY TEST(0.1 GPH) D 17.DAILY VISUAL CHECK D 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSERCONTANMENT ;$1,FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTALLED 468 D 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS D 5.TRENCH LINER/MONITORING D 3.CONTINUOUS DISPENSER PAN SENSOR WCTH AUTO SHUT OFF FOR D6PENSER+AUDIBLE AND VISUAL ALARMS D 6.NONE 469 IX.OWNER/OPERATOR SIGNATURE I unify Nat the infor atio vided herein is hue and actuate to the be,ofmy knowledge. SIGNAT BRAIDS DATE l L/Z(, A f 47: NAMEO R(OPRA,��QpR(prmt) 471 TITLE OF OWN PHRATOR 472 Perak Number(For local we only) 473 P;7t Appmvcd(F.,local use aN Y) 474 Permit Eaphimn Dak(For last use only) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form 13