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r � • <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> VI.PIPING CONSTRUCTIONCheek allthata 1 Page of <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE I.PRESSURE O 2.SUCTION O 3.GRAVITY 458 [11.PRESSURE O 2. SUCTION D 3.GRAVITY 459 <br /> CONSTRUCTION .SINGLE WALL O 3.LINED TRENCH D 99.OTHER 4690 1.SINGLE WALL D 95.UNKNOWN 463 <br /> MANUFACTURER[(�2.DOUBLE WALL O 95.UNKNOWN O 2.DOUBLE WALL O 99.OTHER <br /> MANUFACTURER "I MANUFACTURER 463 <br /> Cl 1.BARE STEEL 06 <br /> FRP COMPATIBLE w/10094 METHANOL Cl 1.BARE STEEL O 6.FRP COMPATIBLE W/100%METHANOL <br /> [12.STAINLESS STEEL D 7.GALVANIZED STEEL O Unknown O 2. STAINLESS STEEL O 7.GALVANIZED STEEL <br /> [13.PLASTIC COMPATIBLE W/CONTENTS [199. Other 03. PLASTIC COMPATIBLE W/CONTENTS [18.FLEXIBLE(HDPE) D 99. OTHER <br /> K4.FIBERGLASS D S.FLEXIBLE(HDPE) O 4, FIBERGLASS [19.CATHODIC PROTECTION <br /> D 5,STEEL W/COATING O 9.CATHODIC PROTECTION 464 O 5. STEEL W/COATING D 95.UNKNOWN 465 <br /> VII.PIPING LEAK DETECTION(Check all natality)(A demi ion ofthe territorial,mignon shell be aubmined to the local <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 061 <br /> PRESSURIZED PIPING(Check.]]thetepply): PRESSURIZED PIPING(Check.]]thmapply): <br /> ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT [11. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WTf AUTO PUMP <br /> OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. <br /> ❑2.MONTHLY 0.2 GPH TEST [12. MONTHLY 0.2 GPH TEST <br /> ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) [13.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> [14. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all fiat apply) <br /> D 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING D 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): D 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW O7. SELF MONITORING <br /> D 9.BIENMAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): <br /> O 8. DAILY VISUAL MONITORING <br /> O 9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Checks][that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> AARMS AND(Check one) ALARMS AND(Check one) <br /> a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS O a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> ❑b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM O b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> s[ Oc. NO AUTO POMP SHUT OFF On NO AUTO PUMP SHUT OFF <br /> KI <br /> 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT O 11 AUTOMATIC LEAK DETECTOR <br /> /- OFF OR RESTRICTION <br /> O 12, ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPID <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> O 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> D 14. CONTINUOUS SUMP SENSOR WITH 011T AUTO PUMP SHUT OFFO14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF" <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> D I5. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW D 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> O 16.ANNUAL INTEGRITY TEST(0.1 GPH) [116.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> [117. DAILY VISUAL CHECK O 17. DAILY VISUAL CHECK <br /> VIII,DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT O 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK <br /> DATE VITALLED 468 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS D 5.TRENCH LINER/MONITORING <br /> �- 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR D 6.NONE 469 <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> 1«nify1lutthein inion provided herein is we and accurate to the been of my knowledge. <br /> SIGNATU OFO E PE DATE r� 400 <br /> 7AIV <br /> 'NTO (print 471 ITLE OF OWNEK/OPEKA OR 473 <br /> Permit Number(For local use only) 473 Permit Appmvcd(Far local use only) 414 Permit Expiration Date(For local use only) 475 <br /> UPCF(12/99 revised) 12 Formerly SWRCB Form B <br />