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U NIF IED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION(Chk0"appy) UNDERGROUND RVING ABOVEGROUND PIPING SYSTEM TYPE 1 PRESSURE ❑ 2. SUCTION ❑ 0. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 0. GRAVITY CONSTRULTIOW ❑ 1. SINGLE WALL ❑ 0. LINED TRENCH ❑99. OTHER ❑ i. SINGLE WALL 1195. UNKNOWN MANUFACTURER 2 DOUBLE WALL �/'/I FrI 95 U ONM [ ❑ 2 DOUBLE WALL ❑99. OTHER MANUFACTURER : L r l f/� MANUFACTURER ❑ 1.BARE STEEL ❑ e. FRP COMPATIBLE WI 1D3%METHANOL ❑ 1. BARE STEEL ❑ S. FRP COMPATIBLE WI 1013%METHANOL MATERIALS AND ❑ 2_ STAINLESS STEEL ❑ ]. GALVAN12ED STEEL ❑ 2. STAINLESS STEEL 11 ]. GALVANIZED STEEL CORROSION PROTECTION ❑ 0. PLASTIC COMPATIBLE WIN CONTENTS 09. UNKNOWN ❑ 1 PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEKIBLE(HOPE) ❑99. OTHER 4. FIBERGLASS ❑ S. FLEKIBLE(HDPE) ❑99 OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION Cl 5. STEEL WI COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑95. UNKNOWN VIL PIPING LEAK DETECTION(Ch a puf appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check as that appy): PRESSURIZED PIPING(Chec4 at Mot appy): ❑ I. ELECTRONIC UNE LEAK DETECTOR 0 0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 0.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ALARMS 112. MONTHLY 02 GPM TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 0. ANNUAL INTEGRITY TEST(0.1 GPM) 11 ]. ANNUAL INTEGRITY TEST(D.1 GPM) ❑ A DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(CheckYM,apply): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPINGSYSTEM TEST(OI GPM) ❑ S. TRIENNIAL INTEGRITY MST(0 1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ ] SELFMONITORING ❑ ]. SELFMONITORING GRAVITY FLOW GRAVITY FLOW(CMU as that appy): ❑ 9 BIENNIAL INTEGRITY TEST(01 GPM) ❑ a. DAILY VISUAL MONITORING ❑ B MENNIALINTEGRITYTEST(OAGPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check Y that appy): PRESSURIZED PIPING IChapk as Ilut appy): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND \(Check on•) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUOIBLE AND VISUAL ALARMS AND(rn•c4 aha) �i a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUTOFF WHEN A LEAK OCCURS ❑ 0 AUTO SHUT O PUECTIONOFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM D. O ❑ D AUTO PUMP SMUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NOAUTO PUMP SHUTOFF ❑ c. NOAUTO PUMP SHUTOFF It AUTOMATIC UNE LEAK DETECTOR 13.0 GPM TEST)NTH FLOW SHUT OFF OR ❑ 11 AUTOMATIC LEAN DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST III I GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIOWGRAVITY SYSTEM: SUCTIOWGRAVITY SYSTEM: ❑ 10. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS ❑ U. CONTINUOUS SUMP SENSOR•AUOIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Ch•P4Y Mat appy) EMERGENCY GENERATORS ONLY(CMck as that appy, ❑ fa. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF-AUDIBLE AND ❑ 1/. CONTINUOUS SUMP SENSOR WTTHOUT AUTO PUMP SHUT OFF•AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC UNE LEAK DETECTOR P.0 GPH TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 15. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 1S. ANNUAL INTEGRITY MST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VOL DISPENSER CONTAINMENT O,SPENSER CONTAINMENT I. FLOAT MECMANISM T T SHUTS OFF SHEAR VALVE ❑ a. p.LYVISUALCMECK DATE INSTALLED - - .'CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS ❑ S. TRENCHUNERIMONITORING ❑ 0'6PINTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑ B. NONE UL OWNERIOPERATOR SIGNATURE I .M•KapORaOpRp�via•6 .nN a Vw aha aGv2u u IM W a1 pt mr Ivwwl Wq•. SIGNAT EO_FOWN_ER(OPSAVORate. DATE L, NAM OF OWNS EM R(pam) TITLE OF OWNEWOPERATOR Pa,mK Numi•r(Fwbcat ut•Way) P•rst Appma•a(FWMCaI use"I Pam,Espiriium Dau IFarNcal uta ppy) l CUPAFORM(4199) -`-` FormeM SWRCB Farm B