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7UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS- TANK PAGE 2 TANKS VI.PIPING CONSTRUCTION(cheek au thal a ply) nate 2 ar Z UM)ERGROUNI)PII'1NG ABOVL'GROUND PIPING SYSTEM TYPE ®1.PRESSURE 1:12,SUCTION ❑3.GRAVITY 459 ❑1.PRIStiURE ❑2. SUCTION coNsTRUCTION ❑L SINGLE WAIL ❑3.LINED TRENCH ❑99.0T'HER 46t, ❑3.GRAVITY 459 ❑1.SINCILI;WALL ❑95.UNKNOWN 462 MANUF'ACTURRR 0 2.DOUBLE WALL. ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99,OTHER MANUFACTURER Smith Fiberglass 461 MANUFACTURER ❑I.BARF;STEEL 463 ®6.FRP COMPATIBLE w/I00% MF.TI3ANOL ❑1.BARE STEEL ❑G.FRP COMPATIBLE W/100%MIl lWUl. ❑2.STAINLESS STEEL ❑7.GALVANLZED STEEL ❑Unknown ❑2. STAINLESS STEEL [13.PLASTIC COMPATIBLE W/CONTENTS ❑7.GALVANIZED SM- ❑99. Chher [:]3. I COMPATIBLE W/CONTENTS El S.FLEXIBLE(HDPE) 1199, OTHER ❑4.FIBERGLASS El S.FLEXIBLE(HDPE) LlF 4. FIBERGLASS ❑5.STEEL W/COATING ❑9,CATHODIC pROTECTION 4G4 ❑9•CATHODIC PROTECTION ❑5. STEEL W/COATING ❑95.UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that a } A descr on of the mon tal am shall he submitted to the local at UNDERGROUND PIPINLi SINGLE WALL PIPINGABOVEGROUND PIPING PRESSURIZED PIPING(Check all that apply): 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): ❑1.EIECTRONIC L[NE LEAK DETECTOR 3.4 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ ©1. ELECTRONIC LINE LEAK TTMFAU 3.0 GPH SYS EM AUTO PUMP AUDIBLE.AND VISUAL ALARMS. SHUT'OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.IGPII) ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) El 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING y) INTEGRITY TEST(0.1 GPH) ❑5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING); ❑6, TRIFNNL4L INTEGRITY TEST(0.1 GPH) ❑7.SELF MONITORING GRAVITY FLOWSAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑7. SELFMONITORING ❑9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): ❑& DAILY VISUAL MONITORING ❑9.BIENNIAL INTEGRrrY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check 90 SECONDARILY CONTAINED PIPING that apply)' PRESSURIZED PIPING(Check a0 that 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL aPPIY) ALARMS AND(Check ane) _ f 0. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check one) Ela. 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 DISCONNECTION ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑c. NO AUTO PUMP SHUTOFF DISCONNECTION ❑c NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT' OFF OR RESTRICTION ❑11. AUTOMATIC LEAK DETECTOR ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONIGRAVTTY SYSTEM SUCTION/GRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND NRSUAL ALARMS EMERGENCY GENERATORS ONLY(Check 20 thm apply) EMERGENCY GENERATORS ONLY(('.heck atl that apply) ❑14. CONAUDIBLE AND ❑ D VISUAL ALARMS SUMP SENSOR WITH AUTO PUMP SHUT OFF a AUDIBLE 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 1j15. AUTOMATIC LINE LEAK DETECTOR(3,0 GPH TEST)WTTHpC FLOWAUDIBLE AND VISUAL ALARMS SHUT'OFF OR RESTRICTION ❑15.AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL 13,ITEGRIT'Y TEST(0.1 GPH) ❑17. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VIII DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTALLED 468 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER!MONITORING 2003 IR 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR D15PENSER+AUDIBLE AND VISUAL ALARMS ❑6.NONE 469 IX.OWNER/OPERATOR SIGNATURE gNAMEO the information pr 'dad herein is true and accurate to the best of my knowledge. F TLE RATOR DATE C�z 470 O OPRAT (Print) TITLE pF O NER/ ERATOR KIWI 47? President er(For local use al 473 Petrtdtoved Appr {For laoal trse milt) 474 Pttmil Expiration bare(For local use only) 475 UPCF(12199 revised) 12 Formerly SWRCB Form B