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0 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> ®� TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> WWI : <br /> UNDERGROUND PIPIN ABOVEGROUND PIPING <br /> SYSTEM TYPE 1. PRESSURE 1'2. SUCTION 1'3. GRAVITY I'1. PRESSURE I,2. SUCTION IF 3. GRAVITY 459 <br /> CONSTRUCTION/ IF 1. SINGLE WALL I 3. LINED TRENCH 1'99. OTHER 11. SINGLE WALL r95. UNKNOWN 462 <br /> MANUFACTURE , DOUBLE WALL 195. UNKNOVIJ 12. DOUBLE WALL r99. OTHER <br /> R MANUFACTURER . C) . S k � 461 MANUFACTURER 463 <br /> I' 1.BARE STEEL 1'6. FRP COMPATIBLE WW 100%METHANOL r 1. BARE STEEL 1'6. FRP COMPATIBLE Wte 100%METHANOL <br /> MATERIALS AND r 2 STAINLESS STEEL 1'7. GALVANIZED STEEL 1'2. STAINLESS STEEL I'7. GALVANIZED STEEL <br /> CORROSION <br /> PROTECTION 1'3 PLASTIC COMPATIBLE WITH CONTENTS 1-95. UNKNOWN 1'3. PLASTIC COMPATIBLE WITH CONTENTS r 8. FLEXIBLE(HDPE) 1'99. OTHER <br /> 4. FIBERGLASS 1'B. FLEXIBLE(HDPE) 1"99. OTHER 14. FIBERGLASS 1'9. CATHODIC PROTECTION <br /> 1'5. STEEL W9 COATING 1'9. CATHODIC PROTECTION 464 I'S. STEEL WW COATING r 95. UNKNOWN 465 <br /> -ka0 nA"Rer" 'a <br /> .. «.. <br /> . ;. V(F P1PEAC SSEFETfON[Csek a/nth p di) temonn4P9t�rrsh� ..s RedtQ 1c5ea °?. .. x <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> I' 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR IF 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK <br /> LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS <br /> ALARMS <br /> I' 2 MONTHLY 0.2 GPH TEST <br /> I' 2. MONTHLY 0.2 GPH TEST <br /> I' 3. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 1' 3. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 1' 4. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check alt that apply): <br /> 1' S. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY 1' S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> TEST(0.1 GPH) r 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> I' 7. S ELF MONITORING 1' 7. SELF MONITORING <br /> GRAVITY FLOW. GRAVITY FLOW(Check all that apply). <br /> 1� 9. B IENNIAL INTEGRITY TEST(0.1 GPH) I' 8. DAILY VISUAL MONITORING <br /> 1' 9. BIENNIAL INTEGRITY TEST(O.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND <br /> (Check one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) <br /> XAUTO PUMP SHUT OFF WHEN A LEAK OCCURS I a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION r b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION <br /> T c. NO AUTO PUMP SHUT OFF r c. NO AUTO PUMP SHUT OFF <br /> 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR <br /> RESTRICTION I' 11.AUTOMATIC LEAK DETECTOR <br /> 1' 12. ANNUAL INTEGRITY TEST(0.1 GPH) r 12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: <br /> 1' 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS r 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUALALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> I'14. CONTINUOUS SUMP SENSOR VITHOUTAUTO PUMP SHUTOFF+AUDIBLE AND I' 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL <br /> VISUAL ALARMS ALARMS <br /> 1' 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR r 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> RESTRICTION <br /> 1' 16. ANNUAL INTEGRITY TEST(0.1 GPH) 1' 16. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 117. DAILY VISUAL CHECK r 17. DAILY VISUAL CHECK <br /> N� <br /> " a K "M <br /> DISPENSER CONTAINMENT 11. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE I 4. DAILY VISUAL CHECK <br /> DATE INSTALLED 468 CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS r 5. TRENCH LINER/MONITORING <br /> I'3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS I'6. NONE 469 <br /> ., ._ <br /> :;I)C Q,UV)JE{7)fSPERATOR SIGNATURE77 <br /> I certify that tt a information provided herein is true and accurate to the best of my knowledge. <br /> SIGNAT ✓F OWN OP,Crt�1T�QR DATE 470 <br /> ce <br /> NAME OF OWNER/OPERATOR(p(pnnt) 471 TITL OF OV\NEP4bPERATi5R 472 <br /> C� <br /> Aft <br /> Permit Number(For local use only) 473 [PermitApjprdWor local use only) 474 Permit Expiration Date(For local use only) 475 <br />