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02/07/2003 13:11 2094693433 FIFTH FLDD2 PAGE 07 UoED PROGRAM CONSOLIDATED FORM TANK: TA0198404 PRO: FR013 M FACB: FA00D1192 VNAERGROUND STORAGE TANKS -TANK PAGE z VI.PIPING CONSTRUCTION fChwx.,n wA,,PPy) Pan)M9 UNDERGROUND PIPING ARCIVEGROUND PIPING SYSIEMTYPE O LARESSUn 0 SUCTION 01GRAVITY .56 ❑ 1 PRESSURE ❑ 2.5{1CTION ❑).GRAVITY SSP eDNNTKv TI SDIGLBWALL M.LINEDTRENCH ❑99,OTH6R +W ❑ 1.SINGLE WAIL El 95.UNKNOWN +MZ jKO�2.DDUOLEWALL 09S.UNRNOWN [3 2.DOUBLE WALL ❑99.OTHER AC UREIC 461 MANUFACTURER IS, ❑ I.BARE STEEL ❑6.PRPCOMP.ATIBLEawwsm67NANM ❑ I.BARESTEEL ❑ 6,FEPC0MPATIBJ VE .ft14MRT1lAN0L Ej 2.STANLES$STEEL ❑I,GALVANIZED S rEEL ❑ 3.STAINLESS STEEL ❑T.GALVANIZEDSREL ❑ PLASTIC COMPATIBLE W/CONTENTS E]95.UNKNOWN ❑ PLASTIC COMPATIBLE WI CONTENTS El-14,UNKNOWN' ®{.FIBERGLASS ❑E.FLEXIBLE(HDPE) ❑".OTHER ❑-.FIBERGLASS ❑&FLEXIBLE(HDPE) ❑99,OTHER ❑5.STEEL WX0A11NG 9.CATHODIC PROTECTION MA ❑ 5STEEL W/COATING O 9.CATHODIC PROTECTION abs VIL PIPING LEAK DETECTION(O,.+I.IhkI mb,)v, oliev vOha momlwiM v:oR awl SaWI,P do lM loin nw ) UNDERGRO PIPING ABOVEGROUNDMINI SINGLE WALL PIPING 4M6 SINGLE WALL PIPING ab) PRESSURIZCD PIPING(ChMR a0 that aPPly): PRESSURIZED PIPING(Cheek HI MMI apply): � I.ELECTRONIC LME LEAK DETECTOR TA CPM TEST WITM AUTO PUMP SHVIOFF 1.ELECTRONICME LEAK DETECTOR3.0 GPM TEST WITH AUTO PUMP SHUT OFF POR LEAK.SYSTEM FAILURE.AND SYSTEM DSCONNECTION-AVDISLE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTKN+AVDIDLEAND VISUALALARMS, VISUALALAMIS. Z.MONTHLY 0.2 GPH TEST ❑2.MON71{LY 0.2 GPHMSr ❑L ANNUAL MTRGRITY MSST(01 GPM) ❑3.ANNUAL INTEGRITY TEST NJ GFH) ❑1.ONLY VISUAL CHECK CONVENTIONAL RUCTION SYSTEMS CONVENTIONALSiCTION SYSTEM (Chvek tl Dal apply) ❑S.DAILYVISUAL MONITORING Op PUMPING SYSTEM.MENNIPAL PIPING ❑S,DA)LYVISIJALmoNRORINOOFPIPTNo ANDPUMPINOSYsT£M M11GRRYMST(D1 GPH) ❑6.TRIENNIAL INTECRITV TEST(D I GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYMMS(NO VALUES IN BELOW GROUNDPIp1NG): ❑ 7.SELF MONITORING ❑T SELF MONITORING cRnvm Plow ❑9.BIENNIAL INTEGRITY TEST 40,1)GPH GRAVITY PLOW(Cbeekall Datnpply): ❑8.DAILY VISUAL MONITORNO ❑9.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED MING SECONDARLY CONTAINED MING PRESSURIZED PIPING(Check all aMt apply): PRESSURIZED PIPING(Check MI Ilse DppIA: 10.CONTINUOUS IURISINE SUMP SENSOR&17X AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE.SUMP SENSOR WITH AUDIBLE AND VISUAL AI.V{M$AND fCkekw,) ALARM$AND(Q"mQ R.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b.AUTO,PIUMPSHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑b.AUTO PUMP SUNT OPr IVR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION D617ONNFITION 1 $'c NOAUTOPUMPSHUTOFF Q C.NOAUTOPUMP5HUTOFF fkII.AUTOMATIC LINE"AA DETECTOR 13.0 GPH TEST I WITH FLOW SH VT OFF OR ❑ 11.AUTOMATIC LEAK DETECTOR RESTRICTION fR 12,ANNUAL INTEGRITY TEST(O I GPH) ❑ 11_AAT'UAL INTEGRITY TEST(0.1 GPH) SUCTIOWGRAVITV SYSTEM SUCTIONICRA VITY SYSTEM ❑ ID.001,TFN000S SUMP SENSORI AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SGNSOR*AUDIBLE ANDVISIIAL ALARMS EMERGENCY GENERA17OASONLY(Checkall6 a 10 EMERGENCY GSNERATOAS ONLY(a kall9ataypb9 ❑ U.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OPP' ❑ 10.CONTINUOUS SUMP SENSOR WfTHOUT AUTO PUMP SHUT OFF• AUDIBLE AND V ISUAL ALARMS AUDIBLE AND VISUAL ALARMS IS.AUTOMATIC CME LEAR.DETECTOR(3.0 GPH TEST)WITHOUT PLOW IS.AUTOMATIC ME LEAK DETECTOR D.0 GFH TEST)WITHOUT FLOW SMUT OFF OR RESTRICTIONnn SHUT OFF OR KESTRICI'ION E] 16,ANNUAL MTEGRITY TEST(III GPH) U IS,ANNUAL INTEGRITY TLS'r(o.1 GPH) l7.DA0.V VISUALCHECK ❑ V.DAILY VISUALCIIECK V)IL DISPErG CONTAINMENT DISPFNSERCONTAMMENT FLOAT MECHANISM THAT SMUTS OFF$NEAR VALVE {.DAILY VISUAL CHECK DATEINSTALLED 90 2.CONTINUOUS DISPENSER PAN'SENSOR'AUDIBLE AND VISUAL ALARMS JWs.TRBiCH LINER/MONFIORD:G 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6.NONE DISPENSEK.AUDIBLE AND VISUAL ALAIUAS +6° EX.O W NER/OPERATOR SIGNATURE IankD6W lk ivRmu:ianpHWtd l.mly h we m6Hmmt w .,at H..%4w SGNATU T DATE -)D 6 ®3 NAMEOFOWNERIOP ping TITI,EOFOWNERTP RA OR oTI 9mni:NwibnlNw lam uwwly) +D Perch.....wlF°•eul,u.rly) a+ omit Eapirnlan N.,(F.,haul an ant)) °75 PTOD01390 EEOOOOS17 12/31/2003 UPCF(12/99 revised)