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UNIFIED PROGRAM CONSOLIDATED FORM
<br /> TANK
<br /> UNDERG�ROU ND T T T E
<br /> Vh PIPING CONSTRUCTION IC et*aii:hatal.pr; Paye a of
<br /> UNDERGROUND PIPING ABOVEGROUND PIPING
<br /> � t.m tPE Z; ;LRE E� SUCTION ���VI n 52
<br /> C3 2. SUCTION ©3 GRAVITY 459
<br /> COQ, iRa �fON ��I 'NGLs NALL 0 j.LINED', J_y _? ER 46u_ ❑ S1N(AE NALL Q 95 AKNOWN 462
<br /> MtiNUFA DCL,BLE W ALL J 9S UNKNOWN ❑2.DOLKr NA.LL ❑99 G7.PER
<br /> Elk
<br /> 461 1A Fav r; P; 463
<br /> - _
<br /> i.PA,E ST�t'� ❑1.3ARE _El. ❑5.FLIP COMPA-161-E WIt00%METHANOL
<br /> (]�12.STAINLESS S-F_tL 1-]7 GAL iA N147C STEEL C12. STA€N1.FSS S EGL ❑7_' HLVANIZEG 5: EL
<br /> 03 PLA1,IL.00MPAT16LE. YtitLONTENTS ❑ag OTHER j ❑3- PL;>SE VVI CONTENTS ❑8 FLEXIB'_E;HDPEI 099. OTHER
<br /> 0 4 FISEnGLASS (�9 FLLxIELE{1DPE) � ❑d. FiB�_RGL��S5 ❑3.C"ATHODiC PROTECTION �
<br /> ❑5.STrF NtC(JATING 09 L'A7 M US+IJ b'ROTECTION 464 Q 5 S1 EEL V11CCA tk ❑95 JNKNOWN 465
<br /> _ .
<br /> YII.PFPING LE:AVC DETECTION. ne�� oil th3t ap y)IA aesr ,iipuon of the n7onirorir,g arc.ir m snau:be submitted-kothe oval
<br /> IT UNDERC,ROUND PIPING !T ABOVEGROUND PIPING
<br /> I
<br /> __- _.�__..-_-.____...___ �._._ _
<br /> SINGLE_WALL PIPING yv� SINGLE WALL PIPING 467
<br /> Pf ESS 1817 PIPING ';h f au In PRESSURIZED PIPING.t,!- kal ,hat apply;
<br /> ❑�1 1 ST VvJH i J' HUT OFA FOR EL Tr�'di lE F. DETECTOR°0 GFH r N FH AU10 PUMP SHUT OFFf 0R
<br /> E K 1 V``iLURE ANJar�rctJ_ "o ONNECT'OPi E �_ 9LRL L_v.I I-Fl.iF•u1RF ANDS'iSTLMDISCONNE..SON AJDIBLEANDVIStlAL
<br /> �LrF�a ALARMS
<br /> 1
<br /> MON PLY E `,PH(EST �'r- tACA LH Y',.2 Py"EST c_ �
<br /> [j 3, NPJUALiPd LCR'Tv?FST;U.' 3_ A dL :IN1E K TEoT,0.1GPHI
<br /> I)AiLl VISUA L
<br /> CC^dVi::NTCv LS::, �1{,h "YS Fay OPiYrFNTICNA 5l,' �10 �Y7Eid5lCheckanitatapnly: f
<br /> ❑,-: CA!_ Vi rR t fa P TRIE'aLl OF PIPINGAND PIMPING SYSTEM
<br /> SAr�!SUZ l"Cili S EP.io j, vA:DEI.'-+ ,Fi 0,P.;�R_UNJPIPI.^.IC I- i iR EfV'VIA lIu L,�f-iT't.FST(0.' iF'111
<br /> (]'7 HF MCiN11 JRK(-- 1J Y 1L)VALVES N B-ELVW GRC+UrdD:'iPING)
<br /> 'RAOTy C, SC L MJ,NITOP:N1,
<br /> ❑'D bi_N FIAL't, _:R +TE 'GPaj vtVi"°f J fCf�e y a tnat a>yb
<br /> ❑'; jl i�l, L..1f 201C3PH
<br /> SECONDARILY CON FAINED PIPING SECONDARILY CONTAINED PIPING
<br /> PIRESSC'RIZ'EED R'L SSIjr�Z D P h di�� C''.Cr a'I thcl apply? '�
<br /> URS 11F K, c&�jP,4PSEP,SDR 71.-aU,',BLEANG111S'-UkALARMSAND
<br /> Hlf A',MP SL L �F�
<br /> 'A,-;-f,,„_.AK OCCURS U. T :HUT OFF'NNEN A LEA 't C'JRS
<br /> b foTChA SFr,_6��- _ _ _ -. -NUS OFF FOR.tAF,S S',`-7._>3 F,a.LILRE AND SYSTEM l
<br /> L71 J P M �Hu-Oc 7 t J�=HUT OEF
<br /> TEST) ',V,v. ..`vFF )P
<br /> R,-STR l i.N U 1
<br /> l
<br /> 12 AtJN�IAL ,'r L'ITV(tr)1(U 1 BPH? � U L, nNN JAL 'VTE.rr iY TE'>T;O.'i GT'Hl
<br /> SUCTION GRAIII''��� cP�" li( :IUi r K t r F}tl I
<br /> I
<br /> 13 ,
<br /> JN11�U'J��• Uh'P e�5�f2-A':I)IBLEAND VIS=JALAILAPIAYl ❑13 iO+LIN,);:;� .�,dPShUS'D2+AUDIBLEAND`v�StALALARM$
<br /> EMERGENCY GENERATORS ONLY tcl-e a Ta!; 6 EMERGENCY GENERATORS ONLY,Crieck all that apply)
<br /> 0114 CONTINUOUS SUMP Sin NSORVviTHO!JTAUl0PUMP SMUTti, r-10O3__ "NO CG'N'WJGI-�.SljVPSENSORWIT'HOUTAUTO PuMPSHUTOFF-AUDIBLE AND
<br /> L
<br /> VISJAALARMS A VISUA_A_ARP:$
<br /> 15 A t2i OP1AT� IN LEA_DE74''1'TOk,3.0 SPH TEST) 1TF C!' F L,'_'�N'HUT CFF OR ❑ ti AIJCPAA�IC_ L--AK DETECTOR{3.0 GPH TEST,
<br /> X71 A GNJ4L IPJ EC'ITr TEST O_I Grlij ❑16. NN 4Jr^L A E;R'i Y'tFST,0.1 GPH)
<br /> Cj 1-, DAILY VISU I IdP; El v L A i" -11At ^ -K
<br /> VIII.DISPENSER CONTAINMENT .-„;
<br /> --
<br /> DISPENSER ❑ aT ME I1ANiSv T4Ai 'ii IT � .` FhF Vf1LV ❑4,DAILe VISUAL HECK
<br /> CONTAINIMENT
<br /> DATE INSTALLED 4h8 ❑< CNTivI.,GUS u:SPENSEP PAN SE.,.;l'R-AUDIBLE AND%,ISIJAt ALARMS ❑5.TR_KCH LLIER'MONITORING
<br /> CONTINt CUo !SFE c EF P N &:SOk JViTH At,-0 SHUT OFF FOR O;SPi A,t_F2-
<br /> AUDIBLE AND VISUAr AL ;M ❑6.NONE 46y
<br /> IX.OWNER/OPERATOR SIGNATURE
<br /> 1 e
<br /> Lr, 470
<br /> J-tik Rho 2d .. Ot £BFICI
<br /> Perr,>t ui,mb0i�I` oC3 ai' �,..- r_�rsvaa Fo.4JCal c.>vnivl Permit EYurat or,Jatr -xxa1 use Oniy1
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