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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 2 VL PIPING CONSTRUCTION(CMck aO Nat appy) UNDERGROUND PIPING ABOVEGROUND PIPING - SYSTEM TYPE t PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ Z. SUCTION ❑ 3. GRAVITY CONSTRUCTIONII, ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑M. UNKNOWN MANUFACTURER 2 DOUBLE WALL n ITT 95.CuNKNOWM/ El 2. DOUBLE WALL ❑99. OTHER MANUFACTURER �1I .J MAT MANUFACTURER ❑ 1.BARE STEEL ❑ 6. FRP COMPATIBLE W1100%METHANOL ❑ I. BARE STEEL ❑ 6. FRP COMPATIBLE Wn00%METMANOL MATERIALS AND 112, STAINLESS STEEL ❑ 7. GALVANIZED STEEL 13 Z STAINLESS STEEL CORROSION ❑ 7. COMPATIBLE PROTECTION ❑ 3. PLASTIC COMPATIBLE PATH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ & FLEXIBLE(HOPE) ❑99. OTHER 111 1. FIBERGLASS ❑ B. FLEXIBLE(HOPE) ❑99. OTHER ❑ a. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5 STEEL WI COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL Wi COATING 1395. UNKNOWN VIL PIPING LEAK DETECTION(C! a/NN appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chock.1 MM apply): PRESSURIZED PIPING(Chock 0 Met apply):SINGLE WALLPIPING ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.O GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION.AUOIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 02 GPM TEST 113 MONTHLY 0.3 GPM TEST 113. ANNUAL INTEGRITY MST(0.1 GPM) ❑ S. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ a. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Cf kMMet appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONRORING OF PIPING AND PUMPING SYSTEM TEST IO I GPM) ❑ 6. TRIENNIAL INTEGRITY TEST 10.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)'. SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELFMONITORING ❑ 7. SELFMONITORING GRAVITY FLOW. GRAVITY FLOW(CM aN Me?Apply): ❑ 9 BIENNIAL INTEGRITY TEST(D 1 GPM) ❑ & DAILY VISUAL MONITORING ❑ 9. BIENNIALINTEGRITYTEST(O.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check AN MM apply) PRESSURIZED PIPING(Chao as Mat appy): 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check ono) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Oix*arle) AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ h AUTO SHUT OFF FOR LEANS.SYSTEM FAILURE AND SYSTEM D. EC130 AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ .. NO AUTO PUMP SMUT OFF ❑ c NOAUTO PUMP SMUT OFF 11 AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11. AUTOAIATICLEAKOETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST IO.I GPM) ❑ 12. ANNUAL INTEGRITY MST IDA GPM) SUCTIONIGRAVITY SYSTEM: SUCTIONIGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(CMck aN Mat apPY) EMERGENCY GENERATORS ONLY(CMck a0 Met appy, ❑ ta. CONTINUOUS SUMP SENSOR VATHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SMUT OFF.AUDIBLE AND VISUAL VISUAL ALARMS ALARMS - ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ '&ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK UID.DISPENSER CONTAINMENT OISPENSERCONTAINMENT 1. FLOAT MECHANISM THATSHUTS OFF SHEAR VALVE ❑ l DAILYVISUALCMECK DATE INSTALLEO ❑ 1 CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER I MONRORING �- ❑ 3' NUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ 6. NONE DL OWNEWOPERATOR SIGNATURE I.-Mr,Mal Ma'mfteM.D.n wqvw"Jeeewl is Mle arM...I.w Ma wt.,mY k IeJ9a. SIGNATUR F OWNERIOPE T DATE„ NAME FOWNERI ERAT to" TITLE OF OWNE&OPERATOR I Parma NumSar(Ferltcal uaa enbl Parmil ApplRvab(Fwlacal uas P/I/y) ParmK lAp+atlon Dala(fxkk:N uaa Bray) CUPAFORM(4)99) ° Formerly SWRCB Farm 8