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f UNNIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION Chcck.11 th.t. l Pa8e_of_ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑L PRESSURE. [12.SUCTION rq3.GRAVITY 458 ❑L PRESSURE 2. SUCTION ❑3.GRAVITY 459 CoNBTRVCTION ❑1.SINGLE WALL ❑3.LINED TRENCH C)'99.OTHER Oso W,SINGLE WALL ❑95.UNKNOWN 462 MANUFAC MFt❑2.DOUBLE WALL ❑95.UNKNOWN / /� ❑2.DOUBLE WALT.. El99.OITMR MANUFACTURER I[I " / 451 MANUFACTURER 463 ❑ I.HARE STEEL ❑6.FRP COMPATIBLE whom METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE Wl100%METHANOL ❑2.STAINLESS STEEL [17.GALVANIZED STEEL ❑Uoktlawu ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE WI CONTENTS ❑99. Other 0 3. PLASTIC COMPATIBLE WI CONTENTS ❑S.FLEXIBLE(HDPE) [199.OTHER Q 4.FIBERGLASS - 0 8.FLEXIBLE(HDPE) ❑4.FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL WICOATING 0 9.CATHODIC PROTECTION 464 ❑S. STEEL WICOATiNq [195.UNKNOWN 465 VILPIPING LEAK DETECTIONChe ,lidta[a Adcacti 'onofdumonitorin shall bembmiuodwthe local e e UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Chub W that apply): PRESSURIZED PIPING(Checkau thatapply): ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST WITH AUTO PUMP SHUT [11. ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TESTWITTI AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. j ❑2.MONTHLY 0.2 OPH TEST ❑2. MONTHLY 0.2 OPH TEST ❑3.ANNUAL INTEGRITY TEST(0.1 oPH) ❑3.ANNUAL INTEGRITY TEST(0.1 GFH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Chock ad dut apply) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING ❑S. DAILY VISUAL MONITOREVO OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 OPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6.TRIENNIAL INTEGRITY TEST(0.1 OPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): II GRAVITY FLOW ©7. S13LFMONITORING r • ❑9.BIENNIAL INTEGRITY TEST(0.1 OPH) GRAVITY FLOW(Check all rhntapply): ❑8. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.i OPH) SECONDARILY CONTAINED_ PIPING SECONDARILY CONTAINED PIPING PRESSURI=PIPING(Check all chat apply): PRESSURIZED PIPING(Chuck all Nut apply): 10. CONTINUOUS TURBINE SUMP SENSOR WUM AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR}VALHI AUDIBLE AND VISUAL ALARMS AND(Cheek ona) ALARMS AND(check one) ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [3 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑e.No AUTO PUMP SHUT OFF ❑e NO AUTO PUMP SHUT OFF ❑11.AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST)3U FLOW SHUT (]11. AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION Q 12. ANNUAL INTEGRITY TEST(0.1 OPH) ❑12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCITONIGRAVTTY SYSTEM SUCTION/GRAVITY SYSTEM `k ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all du[apply) EMERGENCY GENERATORS ONLY(Check ui thatapply) ❑14.CONTINUOUS SUMP SENSOR WIT AUTO PUMP SHUT OFF` ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑15...AUTOMATIC LEVE LEAK DETECTOR(3.0 OPH TEST)WITHOUT FLOW C]15.AUTOMATIC LINE LEAK DETECTOR(3.0 OPH TEST) - SHUT OFF OR RESTRICTION - ❑16.ANNUAL INTEGRITY TEST(0.1 OPH) ❑16.ANNUAL INTEGRITY TEST(0.1 OPH) ❑17.DAILY VISUAL CHECK [317. DAILY VISUAL CHECK E VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT [11.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE []4.DAILY VISUAL CHECK DATE INSTALLED .468 Cl 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER I MONITORINO ❑3.CONTINUOUS DISPENSER PAN SENSOR}VIII{AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS D 6.NONE 45s UL OWNERIOPERATOR SIGNATURE 1 certify Jut the infwmatioa peovided hwcln L true and aeaurate to the but of my knowledge. - .1 SIGNATURE OR!O TOR DATE A2 r 4 0 I I NAME WNERIOPRATO 7 Tl OFOWNERIO ERATOR 472 Prnni[N by(Fw]..I rue only) -473 Permit Appravod(For local ufe only)" Permit Expu.[ion Data(Far local we o,dy) 475 F7 f UPCF(12199 revised) ' 12 Formerly SWRCB Forn3 B l `