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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all that appy') UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑�/1 SINGLE WALL ❑ 3. LINEDTRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER 2. DOUBLE WALL ❑95. UNKNCWI` ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER V ISO!-y MANUFACTURER - ❑ 1.BARE STEEL ❑ 8. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7.GALVANIZEDSTEEL CORROSION 1-I PROTECTION ❑ 3. PLASTIC COMPATIBLE WTH CONTENTS ,❑,/98. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE(HDPE) yN. OTHER 114. FIBERGLASS ❑ 8. FLEXIBLE(HOPE) (q 89. OTHER ❑ 4. FIBERGLASS ❑ 9.CATHODIC PROTECTION ❑ 5. STEELWI COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑95. UNKNOWN VIL PIPING LEAK DETECTION(Check all(hat apply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGL WALL PIPING SINGLE WALL PIPING PPRE RIZED PIPING(Check all that apply): PRESSURIZED PIPING(Chack ad that apply): 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AWO PUMP SHUTOFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2, MONTHLY 02 GPH TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check aANatappy): _ ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) ❑ S.TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING - GRAVITY FLOW - GRAVITY FLOW(Check All that apply): ❑ 9. BIENNIAL INTEGRITY TEST IDA GPH) ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING Nyeck a8 that apply): PRESSURIZED PIPING(CIRI as that apply): 10. CONT UOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Ch om) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARM$AND(ch..one) ey4TO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ e.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [%A.AUTO PUMP SHUT OFF FOR LEAK$,SYSTEM FAILURE AND SYSTEM VTIDISCONNECTION ❑ 0.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION e NO AUTO PUMP SHUT OFF ❑ c NO AUTO PUMP SHUT OFF it. AUTOMATIC UTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR L111.AUTOMATIC LEAN DETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTIONIGRAVITYSYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUALALARMS ❑ 13. CONTINUOUS SUMP SENSOR,AUDIBLE AND VISUALALARMS EMERGENCY GENERATORS ONLY(Chock ep Net appy) EMERGENCY GENERATORS ONLY(CBeck as Maf apply) 014.CONTINUOUS SUMP SENSOR WTHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WTHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION - ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 18. ANNUAL INTEGRITY TEST(0 1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT. DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATEINSTALLED ❑ 2/.BpNTINUOUSDISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS 115. TRENCH LINER I MONITORING L"1(/JCONTINUOUS DISPENSER PAN SENSOR NTH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑B. NONE IX.OWNER/OPERATOR SIGNATURE I ceniy that Ne iniamawn pmVAe4 herein is"a and eavrale b Na Fest of my krwwleL9e. SIGNATURE OF OVMERIOPERATOR pgTE NAME OF OWNER/OPERATOR tpNN) TIRE OF OWNERIOPERATOR Panrd N.tma(ForbcaluseoMy/ Parnit ApplovaE(Forbcs/usamly) Polme EspiraBon DaN(Forbcal use ony) CUPAFORM(4198) - Formerly SWRCB Folm B