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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check aF Mat appy) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE L PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ 1 SINGLE WALL ❑ 3. LINEDTRENCH ❑99. OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER ❑ 2. DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ e. FRP COMPATIBLE WI 100%METHANOL ❑ 1. BARE STEEL ❑ 8, FRP COMPATIBLE WI 1M%METHANOL MATERIALS AND ❑ 2 STAINLESS STEEL ❑ 1. GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 1195. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXIBLE(HDPE) El 99. OTHER d. FIBERGLASS ❑ S. FLEXIBLE(HOPE) 13. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ S. STEEL W/COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W COATING ❑95. UNKNOWN VII.PIPING LEAK DETECTION(Check an that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chock alf that appy): PRESSURIZED PIPING(Check all that appy): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3 0 GPM TEST NAM 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 ALARMS ❑ 2. MONTHLY 0.2 GPH TEST 133. MONTHLY 0 2 GPM TEST 133.ANNUAL INTEGRITY TEST(D.1 GPH) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS'. CONVENTIONAL SUCTION SYSTEMS(Chock all that apply): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM.TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST 10.1 GPM) ❑ 5. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN SELOW GROUND PIPING) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)'. ❑ T SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check ak that appy): ❑ 9 BIENNIAL INTEGRITY TEST IDA GPM) ❑ 9. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING .PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply).: 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 1C_._hyygne) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(UeU ane) UTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION SHU ❑ F. NO AUTO PUMP SHUT OFF ❑ F NO AUTO PUMP SHUT OFF 11 AUTOMATIC LINE LEAK DETECTOR(30 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11, AUTOMATICLEAKDFMCTOR RESTRICTION ❑ 12 ANNUAL INTEGRITY TEST to.1 GPM) ❑ 12, ANNUAL INTEGRITY TEST IDA GPM) SUCTIOWGRAVITY SYSTEM. SUCTIONIGRAVITY 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(Chuck all Mat 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(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 18. ANNUAL INTEGRITY MST(CA GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.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 SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑ B. NONE IX.OWNERIOPERATOR SIGNATURE I comfy Mat the M1.Hr alma pmviaea herein is true aIW accurate to Ma bast of my kpoelea9a. SIGNATURE OF OWMEWOPERATOR GATE NAME OF OWNER/OPERATOR(MM) TITLE OF OWNERIOPERATOR Pannit Number(FPrlxal use oay) P.M It Approya0(Fw Most uae enW Pernik EKpuaton Data(Forlo al use only) CUPAFORM(4/99) Forrrlerly SWRCB Form B