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07/25/2005 15:07 2094683433 EHD PAGE 03 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE z Vl.PIPING CONSTRUCTION icheck all that a I p48t- of- UNDERGKOUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1.PRESSURE D 2.SUCTION 1 ❑5.GRAVITY 458 ❑I.PRESSURE ❑2. SUCTION C3 55.GRAVITY 439 CONSTRUCTION ❑ S(NGLE WALL [13.LINED TRENCH O 99.OTHER i6o ❑I_SIN'GLE WALL ❑93,UNKNOWN a62 hM,WFACTURLIL[22.DOUBLE/WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER R O . 461 MANUFACTURER E31.BARE STEEL ❑6.FRP COhIPATIBLE wN00% METHANOL ❑I.BARE STEEL ❑6.FRP COMPAT®LE W/IDOY.:dETNANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑Unknown O 2. STAINLESS STEEL D 7.GALVANIZED STEEL ❑), STIC COMPATIBLE W(CONTENTS ❑99. Other ❑3. rLASTIC COMPATIBLE a/CONTENTS ❑&FLEXIBLE(HDPE) ❑99.OTHER 4.FIBERGLASS ❑8-FLEXIBLE(HDPE) [36. FIBERGLASS -)9.CATHODIC PROTECTION ❑S,STEEL W/COATING D 9.CATHODIC PROTECTION 46I 1 ❑s. STEEL W/COATING p 95.UNKNOWN 465 V11,PIPING LEAK DETECTION ichook dl thol a I A dwell don of the monitoring toenm to D be euk-nkted W the 1901 a to .) UNDERGROUND PIPrNC ABOVEGROUND PIPING $INGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPIKO(Chcckalt that3pply); PKESSVRIZ ED PIPING(Chcok all that apply)! ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPFI TEST LM I AUTO PUMP SHUT ❑I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST wITH 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. ❑2.MONTHLY 0.2 GPFI TEST ❑2. MONTHLY 0.2 GPM TEST ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑3.ANNUAL INTEGRITY TCST(O.IGPH) ❑d, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS([hmk all thatuPPlY) D S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPINO ❑5• DAILY VISUAL MONITOILING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW OROUNDPIPING): O 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) Q 7.SELF MONITORINGS SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7. SELF MONITORING ❑9,9JENNIAL INTEGRITY TEST(DA GPH) GRAVITY FLOW(Chakallthitipplyk ❑I. DAILY VISUAL MONITORING ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINEDPIPINC SECONDARILYCOYTAINED PIPING PRESSURIZED PIPING(Chink oJtth3l3PPIY)' PRESSURIZED PIPING(Checkall-hot rPPIY): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ID. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL j�ALA S AND IChnk p.te) ALARMS AND to-t one) UTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑3 UTO PUMP SHUT OFF WHEN A LEAK OCCURS C�"b. ALTO PU11P SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 6' AUTO PLNMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Pre. NO AUTO PUMP SHUT OFF NO AUTO PUMP SHUT OFF I'1. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT el I. AUTOMATIC LEAK DETECTOR OFF OR RESTRJCTION ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) Ej 12.ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION/GRAVITY SYSTEM SUCTION/GR\VITY SYSTEM CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13, CONTINUOUS SUMP SENSOR+AUDIBLE ANO VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all(halapply) EMERGENCY GENERATORS ONLY(CTak all thatapply) O 16. CONTMOUS SUMP SENSOR WWITHQ1lI AUTO PUMP SHUT OFF• D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑IS.AUTOMATIC LINE LEAK DFIE•CTOK(3.0 GPM TEST)WJj13QJl.[FLOW 0 IS.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION p 16.ANNUAL INTEGRITY TEST(D.)GPH) [116.ANNUAL U,TEGKITY TEST(DA GPH) ❑17. DAILY VISUAL CHECK 1 ❑17. DAILY VISUAL CHECK Vill.DISPENSER CONTAINMENT DISPENSER CONTANMENT 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑d.DAILY VISUAL CHECK DATE INSTALLED e68 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALAR,ttIS [11.TRENCH LINER/MONITORNG ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑6,NONE 467 DISPENSER AUDIBLE AND VISUAL ALARMS I WN>ERJOPERATOR SIGNATURE I wrtiry Incl dot Infarlltalie A ktn n IL RL r al knewletlse. SIGNATURE OF DATE NAME OF OWN 0 TOR(prinQ aZl lTF OWNE T 472 PtrthitN.,ber(FmrI uWonly) 473 remit APPIWW(For 104.1-.aeonly) ,aya PrmdlExpirationDate(Forlocal Wteasy) CJS UPCF(12/99 revised) 12 Formerly SWRCB Form B