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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND'STORAGE TANKS-TANK PAGE 2 we € V{yPIPAce PINtGOtSTRUCTION(CheckalthataPPh) . r UNDERGROUND PIPI � ': ��; i.> SYSTEM TYPE ABOVEGROUND PIPING 1. PRESSURE ❑ 2. SUCTION ❑3.GRAVITY 1. PRESSURE - - ❑ 2.SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ 1.SINGLE WALL ❑ 3. LINED TRENCH ❑99.OTHER ❑ 1. SINGLE WALL MANUFACTURER ❑ 2, DOUBLE WALL 11 95. UNKN 1195. UNKNOWN -JY fr ❑2. DOUBLE WALL ❑99.OTHER MANUFACTURER L, MANUFACTURER ❑ 1.BARE STEEL ❑ 6. FRP COMPATIBLE W/100%METHANOL ❑ 1.BARE STEEL MATERIALS AND ❑ p, STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 6. FRP COMPATIBLE W/100%METHANOL CORROSION ❑2.STAINLESS STEEL - ❑ 7.GALVANIZED STEEL ' PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ S. FLEXIBLE(HDPE) - ❑99. OTHER t94- FIBERGLASS ❑ S. FLEXIBLE(HDPE) ❑99. OTHER P(4. FIBERGLASS 0S. 5 STEEL W/COATING El 9. CATHODIC PROTECTION ❑ 9•CATHODIC PROTECTION ❑5.STEEL W/COATING ❑95 UNKNOWN " .:Y.rV11�PIPlNG,LEAK DEI'EC'EION(CheckaBthaf aplMY)� , ,g '.,;a '377 UNDERGROUND PIPING - Q-N =WALL PIPING ABOVEGROUND PIPING R SSURIZED PIPING(Check all that apply): SINGLE WALL PIPING PRESSURIZED PIPING(Check all that a 1. ELECTRONIC LINE LEAK DETECTOR GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEMM DISCONNECTION+AUDIBLE AND VISUAL ❑� 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, ALARMS - SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ' ❑ 2. MONTHLY 0.2 GPH TEST ❑ 2.MONTHLY 0.2 GPH TEST - - ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4. DAILY VISUAL CHECK - CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that apply): - ❑ S. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) - ❑ SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) - ❑ 7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ GRAVITY FLOW: 7.SELF MONITORING � � - ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): - ❑ 8.DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING - PRESSURIZED PIPING(Check all that apply): SECONDARILY CONTAINED PIPING - 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND PRESSURIZED PIPING(Check all that apply): 0 eck one) AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) 11 a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 11b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ e. NO AUTO PUMP SHUT OFF ❑c.NO AUTO PUMP SHUT OFF RESTRICTION AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR - RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR - ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONIGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS SUCTION/GRAVITY SYSTEM: - ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS _ EMERGENCY GENERATORS ONLY(Check ad that apply) EMERGENCY GENERATORS ONLY(Check all that apply ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUAL ALARMS 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR ALARMS RESTRICTION ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) - - -❑ 17.DAILY VISUAL CHECK ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPM)- ❑ 17 DAILY VISUAL CHECK ' DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE IN A D ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 114. DAILY VISUAL CHECK ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6. NONE LINER/MONITORING I awry a in 8 provided herein is true and accurate to the Hest of my knowtedpe.IXOWNERIOPERATOR SIGNATURE - SIGNA F DATE NAME P RATO TITL, OWNEFb PERATOR Permit Number(FOrwsl use onlyg Permit Approved(Forloca/use only) Permit Expiration Date(Forlocal use only) :UPAFORM(4/99) Formerly SWRCS Form 8