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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Cried,ad Ular apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1. PRESSURE ❑ Z. SUCTION ❑ 0. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 0. GRAVITY CONSTRUCTION) ❑ t. SINGLE WALL FPO. LINED TRENCH ❑99 OTHER ❑ 1. SINGLE WALL 1195 UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ e. FRP COMPATIBLE W/IW%,METHANOL ❑ 1. BARE STEEL ❑ e. FRP COMPATIBLE W)100%METHANOL MATERIALS AND ❑ 2, STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION PROTECTION ❑ 0. PIASTICCOMPATIBLEWITH CONTENTS 0 9. UNKNOWN ❑ 0. PLASTIC COMPATIBLE VATH CONTENTS ❑ B. FLEXIBIE(HOPE) ❑99. OTHER r <. FIBERGLASS ❑ B. FLEXIBLE(HDPE) ❑99. OTHER. 134. FIBERGLASS 119. CATHODIC PROTECTION ❑ 5 STEEL WICCATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING 1395. UNKNOWN VII.PIPING LEAK DETECTION(Check.9 that pp(,) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Crack all that apply): PRESSURIZED PIPING(Chaco a6 that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 5.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 40 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAN. LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ALARMS ❑ Z. MONTHLY 03 GPM TEST ❑ 2. MONTHLY 02 GPM TEST ❑ y ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 0. ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(ChKk all thaNppry): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(01 GPM) ❑ 8. TRIENNIAL INTEGRITY TEST 10.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW. GRAVITY FLOW(Check an that apply)' ❑ 9. BIENNIAL INTEGRITY TEST(0 I GPM) ❑ B. DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST to 1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING fChack ae that apply): PRESSURIZED PIPING(Check e0 that apply)' 10. CONTINUOUS TURBINE SUMP SENSOR WITHAUDIBLE ANDVISUALALARMSAND (CM.0 Orae) 10,CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(c*ck Ona) (CnNTF ❑ • AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ h AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ 0. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION �011. NO AUTO PUMP SHUT OFF c. NO AUTO PUMP SHUT OFF ❑ tt. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR C311. AUTOMATIC LEAK DETECTOR aaappp RESTRICTION IAD 12. ANNUAL INTEGRITY TEST(01 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIOWOR,VITY SYSTEMSUCTION/GRAVITY SYSTEM'. ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 10. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check ad that apply) EMERGENCY GENERATORS ONLY(Check a9 that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL VISUALAIARMS ALARMS ❑ 1S. AUTOMATIC LINE LEAK DETECTOR(0.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK OATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER I MONITORING ❑ 0. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS NONE IL OWNERIOPERATOR SIGNATURE I Partly Mal Ne inlotmae0n pmvKe0 Nrain Is We aMd accurate b Ne pest or my knmNe09e. SIGNATURE OF EWOPENAT DATE 3. 2e, 01 NAME OF IZWN E RM f rERA TGRIpXFIJ TITLE OF OWNEMPERATOR Petmil Number/FOIIOcal use anly) Parmil AppmveE(FO/but uu On0d Pnmh EA,.wM Data(For)./me OMy) CUPAFORM(4/99) • • Formerly SVVRCB Form 8