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UNIIIKD PROGRAM CON30LIDATI[O FO TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONMUCTION(C71Rk or mail&A*) r UNDERGROUND PIPING A80VEGROUNO PIPING I SYSTEM TYPE 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAvrry 45a C] I. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY I I'CONSTRUCTIOW r❑ 1• SINGLE WALL ❑ 3. LINED TRENCH C]99. OTHER 460 C1 1. SINGLE WALL C195. UNKNOWN 462 MANUFACTURERI K11 2. DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER 467 MANUFACTURER 463 ❑ 1.BARE STEEL 6. FRP COMPATIBLE WI 100%METHANOL �} 1. BARE STEEL ❑ 6. FRP COMPATIBLE WI 10071 METHANOL MATERIALSI CORROSION AN ❑ 2, STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAWLESS STEEL ❑ 7. GALVANIZED STEEL I cpARDSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 6, FLEXIBLE(HDPE) ❑99. OTHER ❑ A. FIBERGLASS ❑ e, FLEXIBLE(HOPE) ❑99. OTHER ❑ 4, FIBERGLASS ❑ 9. CATH001C PROTECTION ❑ 5. STEEL.WI COATING ❑ 9. CATHODIC PR07ECT10N 464 ❑ S. STEEL WI COATING 1195. UNKNOWN 46.5 VIL PIPING'LEAK DETECTION(Cthq&atyw app)/ UNDERGROUND MNG ABOVEGROUND PIPING 34NGLE MALL PIPING 466 SINGLE WALt PIPING 467 rA4R SSUfl1ZE0 PIPING(C11dt so Mat appoy): PRESSURIZED PIPING(Chock air Mat apply): IDI 1. ELE17MONIC UNE LEAK DETECTOR 3.0 GPM TEST__--1T1 AUTO PUMP SHUT OFF FOR ❑ 1, ELECTRONIC LINE LEAK DETECTOR 3,0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK LEAK,SYSTEM FAILURE,AND SYSTEM DLSCON14ECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM Twr ❑ 2. MONTHLY 01 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1(3RH) 1. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Cho&&I"&X*): .❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPfNG AND PUMPING SYSTEM TEST(0,1 GPM) ❑ S. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS{NO VALVES W BELOW GROUND PIPINGI: SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7- SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW(Chock ar Mat apply): 9. 91ENNIAL INTEGRITY TEST(0.1 GPM) ❑ 6. DAILY VISUAL MONITORING ❑ 9. BIENNIAL CNTEGRI Y TEST(0,1 GPH) SECONDARILY CONTAINED PIPING SECONOARILY CONTAINED PIPING PRESSURIZED PIPING(Cheer aA that aopy): PRESSURIZED PIPING(Check as that apody): I0, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VLSUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(cneck (Check one) ore) �s �,❑ ■. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS C1 a. AUTO PUMP SHUT OFF WHEN A LEAH(OCCURS L4 b. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION y� Cl C. NO AUTO PUMP SHUT OFF ❑ e. NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR(3-0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11. AUTOMATIC LEAX DETECTOR ❑ 12. ANNUAL INTEGRITY TEST(0,1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPMI SUCTIOWGRA.VrtY SYSTEM: - 13. CONTINUOUS SUMP SENSOR+AUCIBLE AND VISUAL ALARMS SUCTHJFUGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS f EMEAGENCY GENERATORS ONLY(Chock 0IriataA*) ❑ 14. CONTINUOUS SUMP SENSOR WIYHO AUTO PUMP SHUT OFF+AUDIBLE AND EMERGENCY GENERATORS ONLY(Check aY that appy) VISUAL ALARMS - ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ALARMS ❑ IS. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) FLOW SHUT OFF OR RESTRICTION ❑ I S. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPM) 17, DAILY VISUAL CHECK ❑ 1e. ANIN NUAL TEGRITY TEST(0.1 GPM) '❑ ' ❑ 17 DAILY VISUAL CHECK j VIQ•DISPENSER CONTAINMENT I�DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK I GATE INSTALLED 4ee 2, CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING I ❑ 3. CONTINUOUS DISPENSER PAN SENSORrtM (AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑ G. NONE 469 DL OWNERMPERATOR SIGNATURE , I Canty Ih Ri inlorm ded heroin 11 VNtl M10&=L"le 10 STM b411t of/Try kr4wedo. SIGNAYORE10F OW RATOR DATE 470 , f Le-v I I r NAME OF OWNERJOPERA (pnnl) 471 TITLE OF ERIO TOR 472 Tim Juif I Ag477 weer 10m 1 NUM or If-or AXA0 Use qty) 413 Perm)ApprowwT(FarkDcs0 Uaa orvy) 474 ` PwM%I EapirallOR Oaf4(AOT AoCJ)use; 475 UPCF 11199} FGrmody SWRCS FOrrm 8