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UNIFIED PROGRAM CONSOLIDATED FORM , TANKS UNDEF�RGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Clrxk a0 flwtappM UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ 1. SINGLE WALL ❑ 3. 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 ❑ B. FRPCOMPATIBLEW/100%METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE WI 100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ ], GALVANIZEDSTEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXIBLE(HDPE) ❑99, OTHER 4. FIBERGLASS ❑ B, FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 10 5. STEEL WI COATING 1195. UNKNOWN NL PIPING LEAK DETECTION(Check a0 fhetf W UNDERGROUND PIPING ABOVEGROUND PIPING SINGLEWALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check 10low apply): PRESSURIZED PIPING(Check eN that appy): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM 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 A ARMS ❑ 2. MONTHLY 0.2 GPH TEST 112 MONTHLY 03 GPM TEST . 113. ANNUAL INTEGRITY TEST(III GPH) ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS'. CONVENTIONAL SUCTION SYSTEMS(CII sorter appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING); ❑ 7. SELFMONITORING ❑ ]. SELF MONITORING GRAVITY FLOW'. GRAVITY FLOW(Check all that apply): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0 1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check a0 that apply). PRESSURIZED PIPING(Check all that appy)' 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check ane( 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ e. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ h AUTO HU 11OBOUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION O, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c, NO AUTO PUMP SHUT OFF ❑ 11 AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11 AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST(0A GPM) ❑ 12. ANNUAL INTEGRITY TEST(0 1 GPM) SUCTIOWGRAVITY SYSTEM'. SUCTION/GRAVITY SYSTEM'. ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR.AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check as fhat appy) EMERGENCY GENERATORS ONLY(Chock a0 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 VISUALALARMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR is 0 GPM TEST)WITHOUT FL0W SHUT OFF 0R ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ le. ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17. DAILYWSUALCHECK ❑ 17. DAILY VISUAL CHECK VBI.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ i. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ 6. NONE IX.OWNER/OPERATOR SIGNATURE I Family that Ne information provided herein is hue and acawate to Ne Oast of my knoMed9e. SIGNATURE OF OWNER/DPERATOR DATE NAME OF OWNERIOPERATOR(pdn0 TITLE OF OWNERiOPERATOR Pai1n9 Numtvr(Forlocal uas ony) Permit Approved(Forlaca)uae pW Panna Expiration Date(Forbin uae any) CUPAFORM(4/99) Formerly SWRCB Form B