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13 �J SI3�foY UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION Chat en lWt Palle,_of UNDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE 0 1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 459 1 0 1.PRESSURE ❑2. SUCTION 0 3.GRAVITY 459 mNSFRUCION 0 1.SINGLE WALL 0 3.LINED TRENCH O 99.OTHER 460 0.1.SINGLE WALL 0 95.UNKNOWN 462 aaANUFACFURER [12.DOUBLE WALL [195.UNKNOWN [12.DOUBLE WALL 0 99.OTHER MANUFACTURER 461 MANUFACTURER 40 0 1.BARE STEEL 0 6.FRP COMPATIBLE whm METHANOL 0 1.BARE STEEL 0 6.PRP COMPATIBLE wnodu mETHANoL 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 Unlmown 0 2. STAINLESS STEEL ' 0 7.GALVANIZED STEEL 0 3.PLASTIC COMPATIBLE W/CONTENTS 0 99. OR= [:13. PLASTIC COMPATIBLE W/CONTENTS [18.FLEXIBLE(HDPE) 0 99. OTHER ❑4.FIBERGLASS 0 S.FLEXIBLE(HDPE) 04. FIBERGLASS O 9.CATHODIC PROTECTION ❑5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 CIS. STEEL W/COATING 0 95.UNKNOWN a0 VII.PIPING LEAK DETECTION(M.kall w' I Abmcrptim ofineme-aeon m Nall be eutmimd w Na lane UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Oracle m mat apply): PRESSURIZED PIPING(Chet all rhm apply): ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST MM AUTO PUMP SHUT 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST wrTTFf AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ y AUDIBLE AND VISI IAL ALARI.S. AUDIBLE AND VISUAL ALARMS. - ❑2.MONTHLY 0.2 GPH TEST 0 2. MONTHLY 0.2 GPH TEST ` 0 3.ANNUAL INTEGRITY TEST(0.1 GPH) 0 3.ANNUAL INTEGRITY TEST(1).1 GPH) Fj 04. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chert allthmapply) 0 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) _ 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELF MONITORING 0 9.BIENNIAL INTEGRITY TEST(0.I GPH) GRAVITY FLOW(M-1,all rhm apply): 0 S.DAILY VISUAL MONITORING 0 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Deck all leen apply): PRESSURIZED PIPING(Check all thm appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Creek one) ALARMS AND(Crack me) 0 b AUTO PUMP SHUT OFF WHEN A LEAK OCCURS O e AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM O b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Oc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION 0 11. AUTOMATIC LEAK DETECTOR 0 12.ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCDON/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chrst all tMc apply) EMERGENCY GENERATORS ONLY(Check all ljeo apply) 0 14. CONTINUOUS SUMP SENSOR W ITHOfTf AUTO PUMP SHUT OFF• 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 0 15. AUTOMATIC LIKE LEAK DETECTOR(3.0 GPH TEST)WITHOUT,['FLOW SHUT OFF OR RESTRICTION 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) 0 17.DAILY VISUAL CHECK O 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 0 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK DATE INSTALLED a66 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 S.TRENCH LINER/MONITORING 0 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6.NONE 469 IX.OWNER/OPERATOR SIGNATURE lanry thu rre info tin pmvi46 Fe ick ccunm mNe ben of my owledgc SIGNA 0 RAT DATE FR/OPRATOR ring 471 TITLE OF OWNER/OPERATOR 472 77wPemul Number(Fm local un mly) 474 3 Permit Appmva4(For lI.,use only) Parrot Expinron Date(For lonl use only) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form B • o