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T�'� UNIFI, PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE VI.PIPING CONSTRUCTION(fhack 8d Mat apPto ABOVEGROUND PIPING i ❑ 3. GRAVITY ❑ 2. SUCTION )NOERGROUND PIPING ❑ 3. GRAVITY ❑ 1. PRESSURE (395. UNKNOWN iY57EM TYPE ❑ 2 1. PRESSURE SUCTION ❑99. OTHER C3 I. SINGLE WALL ❑99. OTHER C31. SINGLE WALL ❑ 3. U14ED TRENCH ❑ 2 DOUBLE WALL CONSTRUCTIOW ❑95. UNKNOWN MANUFACTURER MANUFURER 0 2. DOUBLE WALL _ ❑ g. FRP COMPATIBLE WI loox METHANOL ACT MANUFACTURER C31. BARE STEEL ❑ 7 GALVANIZED STEEL ❑ t.BARE STEEL ❑ g. FRP COMPATIBLE Wl 1009 METHANOL ❑ 2. STAINLESS STEEL ❑ g. FLEXIBLE(HDPE) ❑99. OTHER 7. GALVANIZED STEEL ❑95 UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS MATERIALS AND ❑ 2. STAINLESS STEEL ❑ ❑ 9. CATHODIC PROTECTION CORROSION ❑ 3 PLASTIC COMPATIBLE WITH CONTENTS ❑99 OTHER ❑ 4. FIBERGLASS ❑95. UNKNOWN ♦, FIBERGLASS PROTECTION ❑ g FLEXIBLE(HDPE) ❑ 5. STEEL'IV'COATING $� ❑ g CATHODIC PROTECTION aI that apPM C] 5. STEEL WI COATING VII,PIPING LEAK DET>=CTION(mak pgQVEGROUND PIPING SINGIF WALL PIPING UNDERGROUND PIPING ay that apply): PRESSURIZED PIPING(Check SINGLE WALL K. PIPING ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT Off FOR LEA PRESSURIZED PIPING(CAKk aY IMF ePpty)' SY$jFh1 FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ❑ AUDIBLE AND VISUAL t. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SMUT OFF FOR ❑ 2 MONTHLY 0.2 GPM TEST LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION• ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ALARMS CK. DAILY VISUAL CHE ❑ 2. MONTHLY 0.2 GPM TEST ❑ 4 N Mat apply):3, ANNUAL INTEGRITY TEST(0.1 GPM) CONVENTIONAL SUCTION SYSTEMS ❑ 5, DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM CONVENTIONAL SUCTION SYSTEMS: TRIENNIAL PIPING INTEGRITY C] a TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑ 5. DAILY VISUAL MONITORING Of PUMPING SYSTEM TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELF MONITORING ❑ 7 SELF MONITORING GRAVITY FLOW(Ch-k as that aPpo GRAVITY FLOW ❑ a. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ 9, BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check a1 true aplril onPIPING10.apply): VISUAL ALARMS 10.CONTINUOUS TURBINE SUMP SENSOR WITH PRESSURIZED PIPING(Check AUDIBLE AND VISUAL ALARMS AND( Duel SECONDARILY CONTAINED R VN-Tt1 AUDIBLE ❑ a. AUTO PUMP SHUT O AND VIMS ANO FF WHEN A LEAK OCCURS (Chea e' K OCCURS C3b. AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTIONt0. CONTINUOUS TURBINE SUMP SENSO [ a. AUTO PUMP SMUT OFF WHEN A LEA FAILURE AND SYSTEM ❑ b, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM ❑ c� NO AUTO PUMP SHUT OFF DISCONNECTION ❑ 11. AUTOMATIC LFAK DETECTOR ❑ c. NO AUTO PUMP SHUT OFF V�TH FLOW SHUT OFF OR t 1. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)._� ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) RESTRICTION ❑ $UCT3. CONTINUOUS SYSTEM: 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ t3 CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS SUCTIONIGRAVITY SYSTEM: SENSOR•AUDIBLE AND VISUAL ALARMS MEMERGENCY GENERATORS ONLY(Cck all that apply' C313. CONTINUOUS SUMP EMERGENCY GENERATORS ONLY(Clwck sY that appM ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SMUT OFF•AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) o- ❑ t4. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE A VISUAL ALARMS �TrypUT FLOW$HUT OfF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TESTI ❑ t6 ANNUAL INTEGRITY TEST(o.t GPM) RESTRICTION ❑ 15. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT ❑ 4 DAILY VISUAL CHECK ❑ 5, TRENCH LINER 1 MONITORING DISPENSER CONTAINMENT O 2. CONTi UOUS DISPENSER PAN 1. FLOAT MECHANISM THAT TSENSOR SHEAR DATE INSTALLED AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS (3g. NONE 1 (a ® ISPENSER PAN SENSOR`I_?AUTO SHUT OFF FOR DISPENSER 3, CONTINUOUS D IX OWNERIO)ERATOR SIGNATURE La to the best of my knowladgo. I uruN Mx e Il the information Prove is true aham aus GATE SIGNATURE OF OWNERIOPERATOR TITLE OF O'WNERIOPERATOR NAME OF OWNER/OPERATOR(pnnt) Penna Ekwratlon Dau(Forlocal use oroo IpMrat Approved(For local use only) permit Number(For local use only) i m Formertq SWRCS Form B