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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 i >`� YG PIPING CONSTR CTION D ; - / - o' ..._. - _ ,:.,.D 3,....,.,�w'Y�,.�`.__.. �V. fLn.�k. m.f appN ;`..v.€, 5' �`r r_�.+c�� rz� ��`.w,.--..,..-:•- . � _ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 5(l PRESSURE ❑ 2. SUCTION ❑ 3.GRAVITY ❑ L PRESSURE - ❑ 2.SUCTION ❑ 0.GRAVITY' CONSTRUCTION ❑ 1. SINGLE WALL ❑ 3.UNEOTRENCH ❑99. OTHER ❑ 1.SINGLE WALL 1195.UNKNOWN MANUFACTURER2 DOUBLE WALL /' 10 V.UNKNOWN 13Z DOUBLE WALL 1199.OTHER UFACTURSft A R- / h-r MANUFACTURER ❑ 1.BARE STEEL ❑ S.FRP COMPATIBLE WI 100%METHANOL - ❑ 1. BARE STEEL ❑ S. FRPCOMPATIBLEW/l00%METIMNOL MATERMLSAND ❑ 2. STAINLESSSTEEL ❑ T.GALVANDEDSTEEL ❑ 2.STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTKM ❑ 3.PLASTIC COMPATIBLE WITH CONTENTS 1195. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLE)QBLE(HDPE) ❑99.OTHER �4. FIBERGLASS ❑ B.FLERIBLE(HOPE) 1199.OTHER ❑ 4. FIBERGLASS Cl B. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑ 9.CATHODIC PROTECTION ❑ 5. STEEL W/COATING 1195 UN"CO - f• VIL PIPING LEAK DETECTION(Cha<k.9mMf appry7 UNDERGROUND PIPING - ABOVEGROUND PIPING SINGLEWALLPIPING SINGLE WALL PIPING PRESSURIZED PIPING(CheOk Allhat ApPN: - PRESSURIZED PIPING(Ohackld thafvppy): - ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST VATH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK LEAK SYSTEMFAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION e AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2. MONTHLY 0.2 GPM TEST - ❑ ].ANNUAL INTEGRITY TEST(0.1 GPM - ❑ 3.ANNUAL INTEGRITY TEST(OA GPM) ❑ /. DAILY VISUAL CHECK CONVENTIONAL SLIOTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(CMck ad fhaf appy): ❑ S.DAILY VISUAL MONITORING OF PUMPING SYSTEM a TRIENNIAL PIPING INTEGRITY ❑ S.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ S.TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T.SELF MONITORING ❑ T.SELF MONITORING GRAVITY FLOW. - GRAVITY FLOW(Chack ad flMf appy): Cl 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ S. DAILY VISUAL MONITORING - ❑ 9. SIENNIALINTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Chock ad Oat APPY/: PRESSURIZED PIPING(CnoOk ad that appy): 10 CONTINUOUS TURBINE SUMP SENSOR KITH AUDIBLE AND VISUAL ALARMS AND 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDI BLE AND VISUAL ALARMS AND cne one ICnNTI one) ( l a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a.AUTO PUMP SMUT OFF WHEN A LEAK OCCURS !.AUTO PUMP SMUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ h,AUTO PUMP SMUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ e NO ALTO PUMP SHUT OFF ❑ c NO AUTO PUMP SHUT OFF 011.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11.AUTOMATICLEAKOETECTOR RESTRICTION ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONGRAVITV SYSTEM: SUCTION IRAVITYSYSTEM: ❑ 13.CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS 013.CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check aD IIMf appy) EMERGENCY GENERATORS ONLY(Deck a1 Naf app&•) ❑ 14.CONTINUOUS SUMP SENSOR VATHOUT AUTO PUMP SHUT OFF A AUDIBLE AND ❑ N.CONTINUOUS SUMP SENSOR WTHOUTAUTO PUMP SHUT OFF.AUMBLE AND VISUAL VISUAL ALARMS ALARMS - ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION - - ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPM) 111T. DAILY VISUAL CHECK ❑ 1). DAILY VISUAL CHECK . . .'*+VN.SISPENSER CONTAINMNT 9�. DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF$HEAR VALVE - ❑ 4. DAILY VISUAL CHECK DAMINSTALLEO ❑ 2 CONTINWUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ S.TRENCMUNERIMONRORING .CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER a AUDIBLE AND VISUAL ALARMS ❑ 8. NOrvE DL OWNERIOPERATOR SIGNATURE I nrVy MINA NlOrma9on pmNCed hvaln of true and amrata to Me Beet Of MY MOMad9a. SIGNATUREOFOWNID/OPERATOR _ DATE C NAME OF CVMER/OPER. 9:dnd TITLE OF OVMERVOPERATOR Pamul NumEar(Forlocal vsa oryO PemNApp *d(Forkx&I VONy) • PemM E�SOn Data(fO/N.vl we anryJ CUPAFORM(4/99) - Formerly SWRCB Farm B