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UNIFIED PROGRAM CONSOLIDATED FORM 3 TANKS UNDERGROUND STORAGE TANKS-T K PAGE 2 VI.PIPING CONSTRUCTION01-c 411(WABOVEGROUND PIPING UNDERGROUND PIPING 459. SYSTEM TYPE El 1.PRESSURE 460.❑2.SUCTION ❑3.GRAVITY 40, i]1.PRESSURE ❑2.SUCTION ❑3.GRAVITY --I V CONSTRUCTION/ El 1.SINGLE WALL ❑3.UNE.TRENCH ❑99.OTHER El L SINGLE WALL M 95.UNKNOWN 462. MANUFACTURER 0 2.DOUBLE WALL C&95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER 461. MANUFACTURER 463. MANUFACTURERE]6.FRP COMPATIBLE w/100%METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE W/100%METHANOL 2.1.BARESTAISTEELLESS TEEL El 7. GALVANIZED STEEL El 2.STAINLESS STEEL ❑7.GALVANIZED STEEL El3.PLASTIC COMPATIBLE WITH CONTENTS la 95.UNKNOWN El 3.PLASTIC COMPATIBLE W/CONTENTS ❑9.FLEMBLCATHODE(HOPE) CTION ❑WOT}fER E]4.FIBERGLASS ❑S.FLEXIBLE(HDPE) i]99.OTHER El 4.FIBERGLASS 465. q64 ❑S STEEL W/COATING x.95.UNKNOWN [015.STEEL W/COATING El 9.CATHODIC PROTECTION - VILPIPF'rG LG'AKDETECCION(Chec1.Blthal VlY)(pdes9ri Don ofthe 0p4.tonne �oq.ainshAON,KuuND PIPING UNDERGROUND PIPING467. 466. SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check all that apply$ PRESSURIZED PIPING(Check all that apply): ❑1. ELECTRONIC LINE LEAK DETEUMP CTOR 3.0 OPH TEST WITH AUTO PUMP (]i. ELECTRONIC FOR UDIBLE AND VISUAL ALARMS. RE GPH TEST HAUTOP SLECTRO FOR LEAK SYSTEM FAILURE.AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK SYSTEM FAILURE.AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS. El 2, MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 OPH TEST [13. ANNUAL INTEGRITY TEST(0.1 GPH) [13, ANNUAL INTEGRITY TEST(0.1 GPH) E]4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS(Check all that apply) CONVENTIONAL SUCTION SYSTEMS [35. INTEGRITY TEST TEST(0'ITO�NG OF PUMPING SYSTEM+TRIENNIAL PIPING E]5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO V ALVFS IN BELOW GROUND PIPING): E]6. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑7. SELFMONITORING []7, SELFMONTPORING GRAVITY FLAW GRAVITY FLOW(Chock a0 that apply): 9. BIENNIALINTEGRITY TEST(0.1 GPH) Ej S. DAILY VISUAL MONITORING [39. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that aPPIYk 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. po�S AAND(Chacko SUMP SENSOR WITH AUDIBLE AND VIS UAL ALARMS AND(Check One) ❑a.ALTO PUMP SIM OFF WHEN A LEAK OCCURS I]a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM E]b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM b. DISCONNECTION DISCONNECTION Oc. NO AUTO PUMP SHUTOFF Qc. NO AUTO PUMP SHUT OFF ❑II. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 011.AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ❑12.ANNUAL INTEGRITY TEST(0.1 GPH) El 12. ANNUAL INTEGRITY TEST(0.I GPH) SUCRON/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS E] 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all thin apply) EMERGENCY GENERATORS ONLY(Check all that apply) [314. CONTINUOUS SUMP SENSOR ITTROUT AUTO PUMP SHUT OFF FI 14.CONTINUOUS AND MP ISSUAL ASO AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW (J 15. AUTOMATIC LINE LEAKDETECTOR(3.0 OPHTEST) SIM OFF OR RESTRICTION I]16 ANNUAL INTEGRITY TEST(0.1 OPH) [316. ANNUAL INTEGRITY TEST(0.1 GPH) 0 17. DAILY VISUAL CHECK [317. DAILY VISUAL CHECK - - Vlll.DISPENSER CON'CAINAIENT DISPENSER COMAINMENT 468. ❑I. FIAAT MECHANISM THAT SHUTS OFF SHEAR VALVE i]4. DAILY VISUAL CHECK 469. DATEINSTALLED i]2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5. TRENCH/LINER MONITORING [33. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR E]6. NONE DISPENSER+AUDIBLE AND VISUAL ALARMS -. _. IX:OWNEwOPERATOR SIGNATURE I certify that the information provided herein is we and accurate tO the best of my knowledge. 470. I NA O ERATOR DATE: F 4n. ITfLEOP OWN PERATOR: N OFOp PE Pemdt Nuatber(Agency um 0dY) 473. Pemut Approved By(Agency use only) 474. 1 Pemtit Ezpi ati0n Date(A9C=Y nae Daly) 475. UPCF hwtwrc-h(1/99)-314 http:/hvww.unidocs.org Rev.02/16/90