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02/07/2003 13:11 2094683433 FIFTH FLOOR PAGE 09 U1&D PROGRAM CONSOLIDATED FORM TANK; TA0190406 w 0 PRO: PRD231954 UNDERGROUND STORAGE TANKS -TANK PAGE 2 FAC P: FA0B01393 VI.PLPING COCTION(nck.xnin.ppy) ft"aa, UNDERGROUND PI AEOVEGROUND PIPTNG $Y5TI2d TYPE ❑ ) RESSURE ❑I,SlICT10N ).GRAVITY 43S I.PRESSURE ❑ 2_SUCTION Q).GRAVITY 450 GDNSTAUOTION LSINGLE WALT, QI.LINEOTRENCH Q99.OTHER ..D QLSNGLEWALL El WI.UNKNOWN ..1 9122.DOUBLE WALL Q95.VNRWOWN Q 2.DOUBLE WALL ❑99.07F2R MANUFACTURER 4w MANUFACTURER IN El I.BARESTEEI. Q 6.FRP COMPATIBLE M 104 MVTHANOL QI."KESTEEL 00.FRI•COMPAT03LE-1 IMYMFIIAWL 0 L STAINLESS STEEL U 7.GALVANIZEDSTEEL Q 2,STAINLESS STEEL Q T.GALVANIZED STEEL 0/1,A-ST IC COMPATIBLE W/CONTENTS ❑95,UNKNOWN O FLAS]'IC COMPATIBLE W/CONTENTS Q 9F,UNKNOWN 1.FIBERGLASS Q S.FLUME(HDPE) ❑99.OTHER Q 4.FIBERGLASS Q S.FLEWDLE(ELOPE) Q 99.OTHER ❑ S.STEEL WICOATNG ❑O.CATHODIC PROTECTION 464 Q 5,STEEL WICOATING ❑9.CATHODIC PROTECTION VII.PIPING LEAK DETECTION(CL:kNapty) UNDERGROUND PITINC: ABOVEGROUND PIPING SINGLE WALT,PTPTNG SINGLE WALL PIPING lRESSURIZED PIPNG(Ckeyk all that apply). PRESSURIZED PIPING(Clink.lblmnpply): I.ELECTRONIC LINE LEAK DET'6CTOR3,0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ I ELECTRONICLNE.LEAK DETECTOR 3UGPH TEST WITH AUTO PUMP SHUT OFF FOR LBAK.SYSTEM FAILURE.AND SYSTEM DISCONNECTION.AUDIBLE AND FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑ Z.MONTHLY OS GPH TEST Q 2.NUN'TNLY D.2 GPH TESL' Q 3.ANNUAL INTEGRITY NEST(0,1 GPH) ),ANNUAL INTEGRITY TEST(D.1 GP}B ❑4.DALLY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(CRuk.111hat appy) Q 5.DAILY VISUAL MONITORING OF'PUMPN'G SYSTEM+TWENNIEAL PIPING ❑S.DAILY VISUAL MONITORING OF POND AND PUMPING SYSTEM IN EGWTYTEsT(0.1 OPHI Q 6.TFJENNIALINIEGIITTYTkTI"(0.1 GPH) AT.SIKTIONSVSTEMS(NO VALUES M BELOW'CROUNDPONCp SAFE SUCTION SYSTEMS(,VO VALUES IN BELOWGROUNDPDINC): ].SELF MONITORING Q T.SELF MONITORING VI'fY FLOW Q 9,BIENNIAL NTEGNTY TEST(0.1)GPN GRAVITY FLOW(CREPT 09 Nal OONY); ❑ I.DAILY VISUAL MONn'OWNG 9.BIENNIAL INTEGRITY TEST(D.I)GPII SECONDARILY CONTAINED PIPINC SECONDARILY CONTAINED PIPING PRFSSUKMI)PIPING(CbeER all Hull appy): PUMURIZED PIFING(Check A Ileal apply): IC CONTNUOUS TURBINE SUMPSENSOR WITH AUDIBLE AND VISUAL IO.CONTINUOUS TURRNE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(LT .) ALARMS AND(Ckeh-0 AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a AUTO PUMP SENT OFF WHEN A LEAK OCLURS Qb.AUTO PUMP SHUT OFF FORL.EAKS.SYSTEM FAILURE AND SYSTEM ❑ b.AUTO PUMP SNOT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION I.NO AU 110 PUMP SHOT OFF Q E.NO AUTO PUMP SMUT OFF Q IL AUTOMATIC LNE I.LAKDETECTOR(1DCPH TEST)WRH PLOW SHUTOFFOR Q 11 AI OMATICLPAKDETECTOR RESTRICTION Q 12.ANNUAL NTECRITV TRSi(D.1 GPII) Q 12,ANNUAL.INTEGRITY TEST(0.1 GPM) SUCI'IONM.RAVITY SYSTEM SUCTION/GRAVTrV SYSTEM Q IT.CONTNUOUSSUMP SENSOR+AUDIBLE AND VISUAL ALARMS Q IS.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(ckn a that Ip h) EMERGENCY GENERATORS ONLY ICEaakilOa aptly) 0 1.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP 31 RT OFF• ❑ 11.CONTINUOUS SUMP SENSOR WITPIOIIT AUTO PUMPSMIT OFF• AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS uI$.AUTOMATIC LINE LEAK DEFECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ 15.AV EOMKfIC UNE LEAK DSI EC1'OR(Am GPH TEST)WITHOUT FLOW SHUT OFF ORMSTRICTTON STRUT OFY OR RESTIUCTION 16,ANNUAL IM'EGRITY TEST IRIOPHI ❑ 76.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ ❑.DAILY VISUAL CI4ECK Q 17.DAILY VISUALCHECK VLDL DISPENSER C0X1ALNMENT DLSPENSERCONTANMENT Q1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE Q 4,DAILY VISUAL CHECK DATE INSTALLED •Ey 2.CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS El S.TRENCH LINER/MfNRORING 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6 NONE DISPENSER+AUDIBLE AND VISUAL ALARMS 460 IX.ON'NE WPERATOR SIGNATURE. Ir-tiy SMO -.I-.w nmaaa.-6 suauti• 1.6. SIGNATURE OF OWNOBDPERATOR DATE / O� 470 NAME OFOWNEA/OPERATOR(prv;O�- TITLEOFOWNEWOPERATOR /L C)�� 112 N�i;NYalba(F.0.1..aab) 4, P-1,Appro146(PNNpA.N1Y) 474 PemnEap,w.wn Dnml lae only) .71 PT0001390 EEOOOOS17 /2/312003 UPCF()2/99 revisttl)