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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check as Nat appy) - UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE X1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTIONI111. SINGLE WALL ❑ 3. LINEOTRENCH ❑99. OTHER 111, SINGLE WALL ❑95. UNKNOWN MANUFACTURER _ DOUBLE WALL 1195, UNKNOWN ❑ 2. DOUBLE WALL ❑99.OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ 0. FRP COMPATIBLE WI 100%METHANOL ❑ 1. BARE STEEL ❑ B. FRP COMPATIBLE W/100%METHANOL MATERIALSAND ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ PLASTIC COMPATIBLE NTH CONTENTS 11 9S. UNKNOWN ❑ 3. PLASTIC COMPATIBLE NTH CONTENTS ❑ B. FLEXIBLE(HDPE) 099. OTHER ' . FIBERGLASS ❑ 0. FLEXIBLE(HDPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING 1195. UNKNOWN VII.PIPING LEAK DETECTION(Check aft that appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chack a9 that appy): PRESSURIZED PIPING(Chaok all that apply): - ❑ i. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST NTH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION a AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION x AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 02 GPM TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS'. CONVENTIONAL SUCTION SYSTEMS(Check al'that apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ $. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. 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. SELFMONITORING GRAVITY FLOW GRAVITY FLOW(Chock aN flat appy): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(O.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check ON Mat apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10.CONTINUOUS TURBINE SUMP SENSOR NTH AUDIBLE AND VISUAL ALARMS AND(tlack one) (Check ane) li ❑ e AUTO PUMP SHUTOFFWHEN A LEAKOCCURS ❑ a.AUTO PUMP SHUT OFF NMENA LEAKOCCURS bAUTONNECTIONTOFF FORLEAKS,SYSTEM FAILURE AND SYSTEM ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION IS'O AVTO PUMP SMUT OFF ❑ C. NOAUTOPUMPSHUTOFF ❑ ATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST to 1 GPM) SUCTIONIGRAVITY SYSTEM'. SUCTIONIGRAVITY SYSTEM. ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR,AU018LE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check aN that apply) EMERGENCY GENERATORS ONLY(Check all Nat apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR`WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 10.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 10. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VRI.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 1. FLOATMEOHANISM THAT SMUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATEI SIAL ❑ 2. CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER I MONITORING 2 ( 4 ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑ B. NONE IX.OWNERIOPERATOR SIGNATURE I calf,Nat Na information I heroin ie n.and eaurane to ye beet of my knoatea9e. SIGNATURE OF OWNER/OPERATOR DATE NAME OF OWNERIOPERATOR(I TITLE OF OWNERIOPERATOR Pamlit Number(Forkcal use my, Panmit ApPrmeE(For focal use omy) Permit Expiration Dane(For local use any) CUPAFORM(4/99) • • Formerly SWRCB Form B