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FROM (THU) JUN 10 2004 12 /ST. 12 ;27/No. 5807953510 P 3 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VL PIPING CONSTRUMON all dpr Page Lf I)NDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPF, I.PRESSURE [12.SUCTION O 3.GRAVITY 458 ❑1,PRESSURE ❑2.SUCTION ❑3.GRAVITY 459 CONSTRUCTION .SINGLE WALL Q 3.LINED TRENCH 0 99.OTHER 460 Q 1.STNGI,F,WA 1,1, ❑95.1 TNKNOWN 46Z MANUFACnAWR 10 2,DOUBLE WALL (]95.UNKNOWN O 2.DOUBLE WALL ❑99.OTHER MANUFACTURER 4k0-rj 461 MANUFACTURER 463 O 1,BARE STEEL ❑6.FRP COMPATIBLE,w/10091 MMAr*)L Q I.BARE sua Q 6,FRP COMPATIBLE W/10016METHANOL O 2.STAINLESS 5TEEL (3 7,GALVANIZED STEEL ❑Unkwwu l]2.STAINLESS STEEL [17.GALVANIZED STEEL V0 LASTIC COMPATIBLE W/CONTENTS - [D 9A Odre+ 0), PLASTIC COMPATIBLE W/CONTENTS 0 1.FLEXIBLE(HDPE) ❑99. OTHER 4.FIBERGLASS ❑9.FLEXIBLE(HDPE) O 4, FIBERGLASS [19.CATHODIC PROTECTION 0 5.STEEL W/(.YXATING ❑9.CATHODIC PROTECTION 4fA r Q S.STEN.WICOATING ❑95.UNKNOWN 465 V LL PIPING LEAK DETR.CI7ON Lbem au Ter A oftbe ebell bantam io M Ioa1 UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 461 PRESSVRIZED PIPING(Ceedc all thr apply): PRESSURIZED PIPING(Check all ter apply): 0 1.ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST WITH AUTO PUMP SHUT (]1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TU,r WITH AUTO PUMP OFF FOR LF,AK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ❑2.MONTHLY 0,2 GPH TEST ❑2, MONTHLY 02 OPH TEST ❑3.ANNUAL INTEGRITY TEST(O.IGPH) ❑3,ANNUAL INTEGRITY TEST(o.iGPH) C34, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Cbeck all em apply) ❑S,DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 1. DAILY VISUAL,MONITORING OF PIPING AND PIIMPINO SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING); ❑6. TRIENNIAL INTeoRITY TEST(0.1 GPH) ❑7,SF,LF MONITORINU SAFE SUCTION SYST EMS(NO VALVES IN bBLOW GROUND PIPINO): GRAVITY FLOW 0 7. SELF MONITORING Q 9,BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Chu*ell"apply): ❑8. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0,1 OPH) SECONDARILY CONTAINED PIPING SF,CONDARII.V C(INTAINED PIPING PRESSURIZED PIPING(OwA.11 d-Apply): PRESSURIZED PIPING(Cemk.0 thr W*Y. 10. CONTINUOUS TURBINE,SUMP SENSOR.=AUDIBLE AND VISUAL I0, CONTLNIJOUS TI IRBINE SUMP SENSOR-WIYH AUDIBLE AND VISUAL ALARMS AND(Oeeck roe) ALARMS AND(Check me) ❑yl AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ©a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS D. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM Q b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE,AND SYSTEM DISCUNNEMION DISCONNECTION ❑e. NO AUTO PUMP SHUT OFF Oc NO AUTO IVMP SHUT OFF ❑1 I. AUTOMATIC LINE LEAK DETECTOR(3A GPH TEST)MW FLOW S14U'T ❑11.AUTOMATIC LEAK DETECTOR OFF ORRESTRICT10N ❑12. ANNUAL INTEGRITY TEST(0,1 OPII) ❑12.ANNUAL INTEGRITY TEST(0.1 GPH) SurnON)GRAVITY S YSTEM SUCTION AGRAVITY SYSTEM ❑13. COWnNUOUSSUMP SENSOR+AUDIBLE AND VISUAL AL,ARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENCRATORF ONLV(Cleft*rl"apply) EMERGENCY GENERATORS ONLY(Check ell ter appy) 1'14. CONTINUOUS SUMP.rmw%nR win 10 IT AUTO PUMP SHUT OFF• ©14.CONTINUOUS SUMP SENSOR iffITH AUTO PUMP SHUT OFF e AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)wYU,UQLU FLOW ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR PUTR1CTION ❑16,ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0,1 OPH) ❑17. DAILY VISUAL CHECK [317. DAILY VISUAL CHECK V IIL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE Q 4.DAILY VISUAL ClI CCR DATE INSTALLED 461 ❑ CONTINUUUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING 103.CONTINUOUS DISPENSER PAN SENSOR Wl AUTO SHUT OFF POR ❑6.NONE 469 DISPENSER r AUDIBLE AND VISUAL ALARMS DL OWNEWOPERATOR SIGNATURE t errtify btu dpe inlbroreUoo PW e.vl.teunh n arc bci a(rrty kmwbdr<e G O TOR DATE 4A N ME OF T OP �22 � .n Paint Nurrb4f (For 1 eGe only) m Perrot Apprw (Fw tory)we mly) 474 Paint Eepaubm (Fork"iter rob) 4TJ UPCF(12/99 revised) 12 Formerly SWRCB Form B