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NIFIED PROGRAM CONSOLIDATED F d TANKS UNDERGROUND STORAGE TANKS - TANK PAGE Z >>ne t V1.PIPING CONSTRUCTION(CAeck ad Mar.mw) I UNDERGROUND PIPING ABOVEORCUNO o'PING SYS-.=m IYPc ❑ 1 PRESSURE L_ Z. 3UC7CN ❑ 3. 3RAVITY ❑ -q ESSURE SUCT'CN ❑ 3. GRAVITY CONSTRUC- NI ❑ 1. 3INGLE'NALL 3. JNED TRENCH ❑39. OTHER I C SINGLE NALL _.:95 JNKNOWN MANUFACTURER ❑ 2. OOUBLE'NALL 'L!95. 'JNKNOWN I❑ Z OCU3L='NALL _.39. 'OTHER MANUFACTURER I MA.U;AC LRE.R ❑ 1.3ARE STEEL ❑ i. FRP COMPAITBLE'NI 100%METHANOL ❑ I. 3ARE 3T 3. =RP COMPATIBLE'M'00%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL LJ 7 GALVANIZED STEEL ❑ L STAINLESS STEEL ❑ 7. GALVANIZED STEEL CCRRCSION PROTECTION ❑ 3. PLASTIC_-OMPA TIBLE'MTH CONTENTS C 95. UNKNOWN I❑ 3. -,-As 1C CCMPAP,BL='MTH CONTENTS ❑ 3. FLEXIBLE IHOP9 ❑99. :OTHER ❑ s. FIBERGLASS ❑ 3. FLEXIBLE(HOPE) ❑99. OTHER ❑ s. FIBERGLASS r 9. CATHODIC PROTECTION ❑ 5. STEEL'N/COATING C 9. CATHODIC PRO i EC7iCN ❑ 5. S i cc_L-W COATING ❑95. JNKNCWN VII.PIPING LEAK DETECTION(Cheat ad lest aaar4 JNDERGROUNO PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Checx all that aDW: PRESSURIZED PIPING(C'uor ad"ret aocryl: ❑ 1. 'ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ L ELECTRONIC UNE LEAK DETECTOR 3.0 GPH'cST'MTH AUTO PUMP SHUT OFF FOR LEAK, LEAK.SYSTEM FAILURE.AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE AND SYSTEM OISCONNEC71ON-AUDIBL=AND VISUAL ALARMS ALARMS ❑ ?_ MONTHLY 0.2 GPM QST ❑ '<. MONTHLY 0.2 GPM TEST ❑ 3. ANNUAL:NTEGRIT'!'tST(0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ s. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS. CONVENTIONAL SUC71ON SYSTEMS(Check ad that WOW: ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-7RIENNIAL PIPING IN,EGRITY i❑ 5. DAILY VISUAL MONITORING OF 21PING AND PIJMPING SYSTEM TEST(0.1 GPM) '❑ 5. �21ENNWL INTEGRITY cST;0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): `SAFE SUCnCN SYSTEMS.NO VALVES;N BELOW GROUND PIPING). ❑ - SELF MONITORING I❑ 7 SELF MONITORING GRAVITY FLOW: I GRAVITY FLOW(Check ad T t apply): ❑ 3. 31ENNIAL INTEGRITY TEST(0.1 GPM) I❑ 3. 'OAILY VISUAL.MCNITORING 3. 31ENNL:L:NTcGRITY EST�O.'GPH) SECONDARILY CONTAINED PIPING I SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Checx an that aoav): PRESSURIZED PIPING,G'»cx ad trw aooM: '0. CONTINUOUS TURBINE SUMP SENSORWITH AU018LE AND VISUAL ALARMS AND '0.CONTINUOUS URSINE SUMP SENSOR`MTH AUDIBLE AND VISUAL ALARMS AND 1 onel ChecK one) ❑ a. AUTO PUMP SHUT OFF'NHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF'NHE.N A LEAK OC,'RS ❑ b. AUTO PUMP SHUT CFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ 1 :UTO PUMP SHUT OFF FCR LEAKS.SYSTEM FAILURE AND SYSTEM CISCONNECTION DISCONNECTION ,1 . N0 AUTO PUMP SHUT OFF ❑ N0 AUTO PUMP SHUT OFF f ❑ N. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTCMArC LEAK DE:EECTCR RESTRICTION ❑ 12. ANNUAL INTEGRITY 7ES7r0.1 GPH) ❑ 1Z. ANNUAL;NTEGRITY EST•:0.1 GPM) SUCTION/GRAVITY SYSTEM: I SUC710WGRAV17Y SYSicM: ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ -3. CONTINUOUS SUMP SENSOR-AUDIBLE ANO VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check ad that apply I EMERGENCY GENERATORS ONLY(Check ad that aaaM ❑ '4. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF-AUDIBLE AND I❑ 14. CONTINUOUS SUMP SENSOR`MTHCUT AUTO PIJMP SHUT OFF-.AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK CETEECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR I❑ 15. AUTCMATIC UNE_:AK QE-.ECTOR(3.0 GPM cS1 RESTRICTION I C '8. ANNUAL INTEGRITY-EST(0.1 GPM) (❑ '8. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ '7. DAILY VISUAL CHECK ❑ t7. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF.SHEAR VALVE ❑ d. DAILY VISUAL CHECK TATE INSTALLED J Z. CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS ❑ i TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER-AUDIBLE ANO VISUAL ALARMS ❑ 9. NONE IX.OWNERIOPERATOR SIGNATURE cem :nat the.ntormabon orov,oeo nereln.s true ata activate to the oest of my Kr 0.wcge. SIGNATURE CF OWNER/OPERATOR 7A. NAME OF OWNER/OPERATOR Ipnntl I lTL=CF CWNER/OPERA TOR o?nnit Numner!For focal use only) '!rmrt Al1pfDVe(1 lFvfopl use Onlyl 'avna taxation Cate iFO/IOCZII use onIVI i CUPAFORM(4199) Form"SWRCS Form 8