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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Checked Natapplyl UNDERGROUND PIPING ABOVEGROUNO PIPING SYSTEM TYPE T PRESSURE ❑L 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3 GRAVITY CONSTRUCTIONI ❑ 1. SINGLE WALL tpU 3. LINED TRENCH ❑99 OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL /❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ B. FRP COMPATIBLE W/100%METHANOL ❑ I. BARE STEEL ❑ & FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION .❑,1 3. PLASTIC COMPATIBLE PATH CONTENTS ❑95. UNKNOWN ❑ ]. RUSTIC COMPATIBLE WITH CONTENTS 13B. FLEKIBLE(HOPE) ❑99. OTHER EI 4. FIBERGLASS ❑ S. FLEEIBLE(HOPE) ❑99. OTHER 114. FIBERGLASS ❑ 9. CATHODIC PROTECTION (((❑ 5. STEEL W1 COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEELWI COATING ❑95. UNKNOWN NI.PIPING LEAK DETECTION(Check N Nat apply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check aN that appy)' PRESSURIZED PIPING(Check as that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 30 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNE(fTION-AUDIBLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS _ ALARMS ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2. MONTHLY 02 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST(0A GPM) ❑ 3 ANNUAL INTEGRITY TEST III 1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that appy): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(01 GPM) ❑ S. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)'. ❑ T SELFMONITORING ❑ T. SELFMONITORING GRAVITY FLOW. GRAVITY FLOW(Check an that apply): ❑ 9. BIENNIAL INTEGRITY TEST 1111 GPM) ❑ B DAILY VISUAL MONITORING ❑ 9 BIENNIALINTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check By that appy): PRESSURIZED PIPING(Check all that apply): 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10,CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(no"one) (Chea one) ❑ • AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ C AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ a. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ t t AUTOMATIC LINE LEAK DETECTOR p.0 GPM TESTI WITH FLOW SHUT OFF OR ❑ 11 AUTOMATIC LEAK DETECTOR ��eyyy RESTRICTION 12. ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 12. ANNUAL INTEGRITY TEST 10.1 GPM) SUCTION/GRAVITY SYSTEMSUCTIONIGRAVITY SYSTEM'. ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13 CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check ad that apPM ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SMUT OFF.AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15.AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)VATHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR Clo GPM TEST) RESTRICTION ❑ 18. ANNUAL INTEGRITY TEST(0.1 GRH) ❑ 15.ANNUAL INTEGRITY TEST R)1 GPM) ❑ 1). DAILY VISUAL CHECK ❑ IT. DAILY VISUAL CHECK VIIL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILYVISUALCHECK DATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSORWITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ a. NONE EX.OW NERNPERATOR SIGNATURE I umr,that M.Inloroaapn provided heroin is Wa and..to to Na Celt at mY ktwalad0e. SIGNATURE OF GVMER/OPERATOR DATE I 3. tel- o NAME OF OVNER'OP ✓TOR nnnno TITLE OF OWNER/OPERATOR PMroit NumCo(For local uv aMy) Permit Approved(Forlacol uxa only) Parrott Eapiraean Data(For kxal uae only) CUPAFORM(4199) • • Formerly SVVRCB Form B