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UNIF PROGRAM CONSOLIDATED F0RM TANKS . � I UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION(Chat►aY that.PPM ABOVEGROUND PIPING .I ❑ 3. GRAVITY ❑ 2, SUCTION ,GROUND PIPING ❑ 3 GRAVITY ❑ 1. PRESSURE ❑95. UNKNOWN ❑ 2. SUCTION M TYPE ] 1. PRESSURE ❑99, OTHER ❑ 1. SINGLE WALL ❑99. OTHER ❑ 1. SINGLE WALL C] 3. LINED TRENCH ❑ 2. DOUBLE WALL TRUCTIOW ❑95. UNKNOWN MANUFACTURER METHANOL IFACTURER 0 2. DOUBLEWALL ❑ g. FRP COMPATIBLE"100% MANUFACTURER ❑ 1. BARE STEEL ❑ 7 GALVANIZED STEEL ❑ 1.BARE STEEL ❑ 8. FRP COMPATIBLE wl 100%METHANOL ❑ , STAINLESS STEEL ❑ g FLEXIBLE(HDPE) ❑99. OTHER ERIALS AND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL 3 ❑ PLASTIC COMPATIBLE VNTH CONTENTS ❑95. UNKNOWN ❑ 9 CATHODIC PROTECTION ROSION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑99 OTHER (34. FIBERGLASS TECTION ❑ a. FLEXIBLE(HOPE) 095. UNKNOWN $] 4. FIBERGLASS ❑ 5. STEEL'Al COATING ❑ S. STEEL Vu COATING ❑ 9. CATHODIC PROTECTION J that APPM VII.PIPING LEAK DETECTION(Ch.ca ABOVEGROUND PIPING SINGLE WALL PIPING UNOERGROUNO PIPING "that apply); PRESSURIZED PIPING(Ch.ca GLE WALL PIPING ❑ 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. ESSURIZEO PIPING(Chad as that apply): SMUT O • SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE ANO VISUAL ALARMS 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP FF FOR ❑ 2- MONTHLY 0.2 GPH TEST LEAK.SYSTEM FAILURE.AND SYSTEM DISCONNECTION'AUDIBLE AND VISUAL ❑ 3 ANNUAL INTEGRITY TEST(01 GPH) ALARMS ] 2. MONTHLY 0.2 GPM TEST ❑ 4. DAILY VISUAL CHECK 3. ANNUAL INTEGRITY TEST(0.1 GPH) CONVENTIONAL SUCTION SYSTEMS(Ch*'a/that apply)' ] ❑ S. DAILY VISUAL MONITORING Of PIPING AND PUMPING DAILY VVI SYSTEM pNVEN SUCTION SYSTEMS: TRIENNIAL PIPING INTEGRITY ] 5. SUAL MONITORING OF PUMPING SYSTEM ❑ �, TRIENNIAL INTEGRITY TEST l0•t GPH) TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING):❑ 7. SELF MONITORING ;AEE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7 SELF MONITORING GRAVITY FLOW(C1t.ck a!1 that apply): GRAVITY FLOW ❑ 9. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) ❑ 9. BIENNIAL INTEGRITY TEST(D.I GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Clyck N Nat apWY): SECONDARILY CONTAINED PIPING t apply) PRESSURIZED PIPING(Ch.cA 10.CONTINUOUS TURBINE SUMP SENSOR VA?H AUDIBLE AND VISUAL ALARMS AND(rTW ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AN VISUAL ALARMS AND SYSTEM FAILURE AND SYSTEM DISCONNECTION (Ch.cx on.) o. AUTO PUMP SHUT OFF FOR LEAKS. a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS C3 b. ❑ 13• AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEMNO AUTO PUMP SHUT OFF DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LEAK DETECTOR WITH FLOW SHUT OFF OR ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) 11 RESTRICTION. AUTOMATIC NE LEAK DETECTOR(3.0 GPH TEST).� . ❑ 12.ANNUAL INTEGRITY TEST(0,1 GPH) SUCTIOWGRAViTY SYSTEM: TOWGRAVITY SYSTEM: ❑ 17. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS SUCSENSOR AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(C-ck aJ N+t apply) ❑ 13. CONTINUOUS SUMP sY that.CPM SUMP SENSOR WITHOUT AUTO PUMP SMUT OFF•AUDIBLE AND VISUAL EMERGENCY GENERATORS ONLY(C-4"J' 0 44. CONTINUOUS ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AN ❑ 15 AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST) VISUAL ALARMS WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK OETECTOR(3.0 GPH TEST) ❑ IIIANNUAL INTEGRITY TEST(0.1 GPH) RESTRICTION ❑ 10. ANNUAL INTEGRITY TEST(O.t GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17 DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT ❑ 4 DAILY VISUAL CHECK I DISPENSER CONTAINMENT ❑ t. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 5. TRENCH LINER l MONITORING GATE INSTALLED ❑ 2.CONTINUOUS DISPENSER PAN SENSOR AUDIBLE AND VISUAL ALARMS 7. CONTINUOUS DISPENSER PAN SENSOR WISH AUTO SHUT OFF FOR DISPENSER�AUDIBLE AND y15UAl ALARMS [30• NONE l O-L tX.OWNERIOPERATOR SIGNATURE vldad h.(.vl-s w.and a="ta to d»13.61 of my knovA*dge GATE I uruN Nat 1M ullortnauon Pro SIGNATURE OF OWNER/OPERATOR TITLE OF CW\VNER/OPERATOR NAME OF OWNER/OPERATOR(Poor) pwmll Espraoon Data(ForloW use only) P.rtnI.Approved(For IoW usa only) P.,nt Numb.t(For local us*oNy) Fo T01Y SWRCB Forth •cnaM ra!991