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UNIFIED PROGRAM CONSOLIDATED FORM - y 3 TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION(Check a9 tMt appy) ABOVEGROUND PIPING UNDERGROUND PIPING SYSTEM TYPE ❑ 2. SUCTION ❑ 3. GRAVITY 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑N. OTHER ❑ 1. SINGLE WALL ❑85. UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL ❑89. OTHER MANUFACTURER 2. DOUBLE WALL ❑85. UNKNOWN - MANUFACTURE0. MANUFACTURER ❑ S. FRP COMPATIBLE W1100%METHANOL ❑ 1.BARE STEEL ❑ 8. FRP COMPATIBLE WI 100%METHANOL ❑ 1. BARE STEEL ❑ T GALVANIZED STEEL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ ]. GALVANIZED STEEL ❑ 2. STAINLESS STEEL CORROSION ❑99. OTHER PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTICCOMPATIBLEWITH CONTENTS ❑ B.CATHODIC PROTECTION . FIBERGLASS ❑ S. FLEXIBLE(HDPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ S. STEELWICOATING ❑ 9. CATHODIC PROTECTION I❑ 5, STEEL WI COATING 095. UNKNOWN VII.PIPING LEAK DETECTION(Chack aO mat appy) ABOVEGROUND PIPING UNDERGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check aO thaf.PPfY): PRESSURIZED PIPING(Check all that apply): PUMP SHUT OFF ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1 SYSTEM OFAIILU EE AND SSYSTEM LEkK TDISCO DISCONNECTION OR LEAK IBLEAND VISUAL ALARMS LEAK.SYSTEM FAILURE.AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ❑ 2. MONTHLY 02 GPM TEST - - ❑ 2.MONTHLY 02GPH TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST Al GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS(Chack as that apply): CONVENTIONAL SUCTION SYSTEMS: ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ 5 TRIENNIAL INTEGRITY TEST(01 GPM) TEST IDA GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ ]. NUFMONITORING ❑ 7. SELFMONITORING GRAVITY FLOW(Check all that apply): GRAVITY FLOW' ❑ ❑ S. DAILY VISUAL MONITORING 9, BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ S. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check e0 that apply): PRESSURIZED PIPING(Check all that appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Nark 0") (Cheek ane) ❑ a. AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS V L3 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b.AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION O ❑ c NO AUTO PUMP SHUT OFF NO AUTO PUMP SHUT OFF 13STRIATION NE LEAN DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST(0 1 GPH) ❑ 12. ANNUAL INTEGRITY TEST IDA GPM) SUCTIONIGRAVIttSYSTEM: SUCTION/GRAVITY SYSTEM: 13.CONTINUOUS SUMP SENSOR�AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR a AUDIBLE AND VISUAL ALARMS ❑ EMERGENCY GENERATORS ONLY(Ch kelt that apPly) EMERGENCYGENERATORS AUTO ONLY SHUT(GNaoOFF AUDIBLE ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14. ALARMS OUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFFi AUDIBLE AND VISUAL VISUALALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAH DETECTOR(3.0 GPM TEST) RESTRICTION 15.ANNUAL INTEGRITY TEST(p.i GPM) ❑ 10.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ ❑ i]. GAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VISI:DISPENSER CONTAINMENT ❑ 4. DAILYVISUALCHECK DISPENSER CONTAINMENT I. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ S.TRENCH LINER/MONITORING DATE IN TA D ❑ 2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS "J ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ 8. NONE IX.OWNER/OPERATOR SIGNATURE certtly Mat Ma Inlormalion pmvMaO Nenin Is We a�M 9Cfu2te to aw bast oT my krwMeE9e. DATE SIGNATURE OF OWNER/OPERATOR TITLE OF OWNMOPERATOR NAME OF OWNER/OPERATOR(ptlnq PermitA meb(For boost uae oMkO Permit Expim9on Data(Forbcal II -My) Permit Number(Foebcel uas only) PP . • Formerly SWRCB Form B CUPAFORM(4199)