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Ali UNIFIED PROGRAM CONSOLIDATED FOR TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check eClha6appfy, UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE gn PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ T SINGLE WALL ❑ 3. LINEDTRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER KDOUBLE WALL ❑95, UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL e. FRP COMPATIBLE WI 100%METHANOL ❑ 1. BARE STEEL 11B. FRP COMPATIBLE WI 100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7. GALVAN12EDSTEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZEDSTEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WI CONTENTS ❑ 8. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEKIBLE(HOPE) ❑0. OTHER ❑ 4. FIBERGLASS ❑ B CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEELW/COATING 1195. UNKNOWN NI.PIPING LEAK DETECTION(Check.all Mefapply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING - PRESSURIZED PIPING(Check aN that apply): PRESSURIZED PIPING(Check ad that apply) ❑ 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION r AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION;-AUDIBLE AND VISUAL ALARMS ALARMS 11 2. MONTHLY 0,2GPH TEST 112. MONTHLY 0.2 GPM TEST ❑ 3. ANNUAL INTEGRITY MST(0.1 GPM) 113. ANNUAL INTEGRITY TEST to GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check Wl Maf apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST 10.1 GPM) ❑ B, TRIENNIAL INTEGRITY TEST 1111 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW(Check no Met apply): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ B. DAILY VISUAL MONITORING ❑ S. BIENNIAL INTEGRITY TEST(O.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check ell that appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Che*one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(ctlerk one) ❑ e. AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS $b AUTO PUMP SHUTOFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ to AUTO PUMP SHUT CFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NOAUTO PUMP SHUT OFF ❑ C. NO AUTO PUMP SHUT OFF 11.AUTOMATIC LINE LEAK DETECTOR(30 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST JOA GPM) ❑ 12. ANNUAL INTEGRITY TEST 1111 GPM) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM. ❑ 13. CONTINUOUS SUMP SENSOR a AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR v AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Che*a8 that appy) EMERGENCY GENERATORS ONLY 11100 Mat apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF-AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUALAURMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.1)GPM TEST) RESTRICTION ❑ 16.ANNUAL INTEGRITY MST(0.1 GPM) ❑ 18. ANNUAL INTEGRITY MST no 1 GPM) ❑ 17. DAILY VISUAL CHECK C] 17. DAILY VISUAL CHECK VIA.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ T FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATEINSTALLEO ❑ 2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL AURMS ❑ S. TRENCH LINER/MONITORING 0 ' 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER v AUDIBLE AND VISUAL ALARMS ❑ B. NONE I%.OWNER/OPERATOR SIGNATURE I runiq Mat Me information Provided herein is Wa and accurate to Me best Of my Mnbvredee. SIGNATURE OF OWNER/OPERATOR PATE NAME OF OWNER/OPERATOR(phn0 TITLE OF OWNER/OPERATOR Permit Number(Far local me orry) Permit Approved(For/xal use orm PemM Eepiratlon Date(Forhral use only) CUPAFORM(4/99) a/�' Formerly SVVRCS Form B