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FROM , (THU) JUN 10 2004 12 /ST. 12;27/No, 6807953510 P 7 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION Pap or <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> CYRTP.M TYPE I.PRESSURE Q 2.SUCTION ❑7.GRAVITY 4511 0 1.PRESSURE C)2. SUCTION ❑3.GRAVITY 459 <br /> CONSTRUCTION Q .SINGLE WALL ❑3.LINED TRENCH 0 99.OTHFR 460 ❑1.SrNOLE WALL Q 95.UNKNOWN 462 <br /> MANUFACiURAIR 2 DOUBLE WALL 093,UNKNOWN ❑2.DOUBLE WALL Q 99,OTHER <br /> �l"L, <br /> MANUFACTURER U- '4 461 MANIJPAM. TRF.R 46) <br /> O 1.BARE STEEL ❑6.FRr COMPATIBLE w/I M% M57NAN01, ❑1,BARE STEEL ❑6.FRP COMPATIBLE wnw%MRTNANo1. <br /> 0 2,STAINLESS STEEL ❑7.GALVANIZED STEF.1, Q Unkttawn ❑2. STAINLESS STEEL O 7.GALVANIM)STEEL <br /> VQ PLASTIC COMPATIBLE W/CONTGNTS [399. Otter ❑3. PLASTIC COMPATIBLE W/CONTENTS Q S.FLEXIBLE(HDPE) ❑99.OTHER <br /> FIBERGLASS ❑S.FLEXIBLE(HOPe) ❑4. FIBERGLASS 0 9,CATI4QDTC rROTECTION <br /> Q 5.STEEL W/COATING ❑9,CATHODIC PROTEM. ON 464 ❑3. STEEL W/COATING Q 93,UNKNOWN 465 <br /> VII.PTPTNG LEAK DETECTION Cbeh a0 the A dlraiobw oro»mowMrwg pragws dug be PAmided w the lou! <br /> UNDF,RGROUND PIPING ABOVEGROUND PIPWO <br /> SINGLE WALL PEPING 466 SINGLE WALL PIPING 467 <br /> PRESSUR17R0 PIPING(Check all 1641 apply FRESSURYLED PIPING(Cteckell mat W*). <br /> ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST WITH AUTO PUMP SHIT Q I, r(1.PCTRONIC LINE LEAK DETECTOR 3.0 OP!(TEST WM AUTO PUMP <br /> OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ <br /> AUDIBLF AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS, <br /> 0 2,MONTI ILY 0.2 UPH TEST ❑2. MONTHLY 0.2 GPH TEST <br /> O 3.ANNUAL INTEGRITY TEST(0.IGPH) Q 3.ANNUAL INTEGRITY TEST(0.IGPH) <br /> Q 4. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Clock all duw poy) <br /> ❑S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIA.PIPING C35. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAF[SUCTION SYSTEMS(NO VALUES IN BELOW OROUNDP1PrNO): 0 6. TRIENNIAL INTEGRITY TUT(0,1 GPH) <br /> 0 7,SELF MONITORING SA E AX TION SYSTEMS(NO VALVES IN BELOW OROUND PIPINGr <br /> GRAVITY FLOW 07, SELF MONITORING <br /> Q 9,BIENNIAL INTEGRITY TEST(0,1 GPH) GRAVITY FLOW(0"all that pply): <br /> ❑S. DAILY VISUAL MONITORING <br /> Q9. BIENNIAL INYWRITYTEST(0.IGPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSUR17r,D PIPING(Check a0 dw appy): PRESSURIZED PIPING(Ow&rl thu pply): <br /> IO, CONTINUOUS TURBINE SUMP SENSOR y..l''Ifl AUDIL9LR AND VISUAL lo. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check me) ALARMS AND(Check-) <br /> Vb. <br /> PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCUki <br /> AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> (NSQONNECI'ION DISCONNECTION <br /> 0g, NO AUTO PUMP SHUT OPP 04 NO AUTO PUMP SI[UT OFF <br /> ❑11. AUTOMATIC LINE LEAK DETECTOR(3A GPH TP,ST)WITH FLOW SHUT ❑1 L AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> Q 12, ANNUAL INTEGRITY TEST(0,1 GPH) Q 12, ANNUAL INTEGRITY TEST(0.1 GPH) <br /> st)CTTON/GRAVITY SYSTEM SUCnON/GRAVITY SYSTEM <br /> 0 19. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL AIARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VIS(IAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Clock rl&u ap*) EMERGENCY GENERATORS ONLY(Check all OW appy) <br /> Q 14. CONTINUOUS SUMP SENSOR WI,TlIpIIi AUTO PUMP SHUT OFF• ❑14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL.ALARMS AUDIBLE AND VI5UALA4ARMS <br /> ❑ <br /> 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WLFLOW ❑15AUTOMATIC LINE LF,AK DETECTOR(3-0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> 0 16,ANNUAL INTEGRITY TEST(0.1 GPH) D 16.ANNUAL INTEGRITY TEST(0.1 OPH) <br /> ❑17, DAILY VISUAL CIIECK 0 17, DAILY VISUAL CHECK <br /> VIIL DISPENSER CONTAINMENT <br /> DISPENSER CUNT AINMENT Q 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE Q 4,DAILY VISUAL CHECK <br /> DATE INSTALLED 468 0�ONnIN <br /> NUGUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS O S,TRENCH LER/MONITORING <br /> 3.CONTINUOUS DISPENSER PAN SENSOR XEM AUTO SHUT OFF POR [16.NONE 469 <br /> r)ISPPNSFR+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> INkWM Ut4 idanuuon 'dad ha ie"w.l. iaw to the b ea of tad ktwcrbd4e. <br /> -O N DATE 470 <br /> OF O R Uwr d _ 47I0 WPERATOR 472 <br /> AZAI <br /> ttber(Fa hl Yee mly) 47) Peml AWwood(Far IOW Yee only) kj 474 U rwrfAt EK*wm (Por IoW a> o*) 475 <br /> UPCF(12/99 revised) 12 Formerly SWRCB Form B <br />