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oiMorea?'-07-03 12 :24P More for Loss 7 209 832 807807S n P.08
<br /> 4
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<br /> UNIFIED PROGRAM CONSOLIDATE4.,FORM •FANIKS
<br /> UNDERGROUND STORAGETANKS -- TANK PAGE 2
<br /> V1,ppi1jr.CONS-17111012110N i0,.1 ABOVEGROUND PIPING
<br /> kNDERGROUNL)PIPING
<br /> 03.(jKAVIIY 4-SK ❑ 1,GRAVITY
<br /> 0
<br /> _S-y-sTr-mrYpt: 4' 0 rl 'ICN A 95.CNKNOWN 462
<br /> 1.ST.4r E1i.LINED TRr-.Ncu 460 0 I..,IN(;Li:WALL
<br /> -LI_
<br /> jIT WALT.
<br /> 02.DOURIPWALL ov):OTHER
<br /> WAI L. 0 95.LNKNOWN
<br /> MA nrREK ❑2.DOUBLE U
<br /> 461 MANUFAC�TLIMR]71Z
<br /> MAW� FAGTURER
<br /> 0 1.nA,Ru--STEEL []6.FRP.. COMPATWLI: W,10W- tMA 'JL. IIMMILS�l EEL,
<br /> L NIZEnq
<br /> 2,STAINLESS STEEL [17 GAI.VANIZILOSTEEL []I:nkmwi STAINLESS STEEL 0 7.GALVA TFFI
<br /> C]3,PLASTIC COMPATIBLE Wj CONTENTS ❑91) rnher [13, PLASTIC COMWILALF W,CONTITNTS [-j S.FLEXIBLE 0417)PE) [],)g oTtir-A
<br /> 4.FIRERGLASS FI.FNIRIT(I IDPL) 01. FILIERULASS 0 9.CATHOUiC.PROTECTION
<br /> []95.UNKNOWNanc
<br /> ❑5.STEEL W,'C-0ATIN(, [3 9,CATHODIC PROTECTION 464 F]5. STr.rtI.W1COATING
<br /> k4l 1.-1 mrd 1A the IACJI A tnCY-)
<br /> VII.PIPING ITAK DETECTION ctjpu*noflhe=r.korinj;pw9r3my
<br /> AEI0VF.KjP()UNr)PIPING
<br /> UNDERGRUUND PIPI'4('.
<br /> SINGLE WALL PIPING SINGLE WAt.l.PIPING
<br /> PRFs.,uF(tzr.DriPIN"G(meek all Itiat3ppIO'
<br /> PRESSUKIZED PIPING 0kull I F1 - T (NIC LINE UE 17ECIOR 3 n I C.P1 I Tr-';T WITI I AUTO PUMP
<br /> 1.]ELLCTRONIC LINE UFAK Dr..TI-, .TION+
<br /> .(,LTou 3.o GVH 7F�;T WTTII AUTO PUNIP SHUT rr R yS I i:m DISCONNEC
<br /> OFF FOR J,TAK.SYSTEM FAILURE,AND SYSTEM DISCONNECTION suLT OFF VOk LEAK,SYAT17M FAILURE.AND S
<br /> AUDIBLE A,NDVISLIAI ALARMS. 2 Aj'njI3j.F AND VISUAL ALARMS.
<br /> 1 MONTHLY 0.2 GPH TEYI_ ❑ _ Njogl HI.V 0 2 GP N Tr..ST
<br /> jy1:ANNUAL INTEGRITY TEST in irm 1) ❑3.ANNUAL INTEGRITY TEST(1).161'1 t)
<br /> 0-3, 0AItyVI1.U7AI.CIlFCK
<br /> CONVENTIONAL SUCTION SYSI EMS CUNYEN UUNAI SUCTIONSYSTr.MS(Check all 11131 aPPIO
<br /> E]5.DAILY VIRUAL MONITOWNG Of Pj:MPINC SYSTEM*TRIFNNMAL PIPING DS. DAILY VISUAL MONITORING OF PIPING AND PUNIPINUSYSFEM
<br /> IvTEGKI'I'Y TEST in I CIVII) E]6 TT(JENNIAI.fNTr.(-,RITYTES'I'(,O.I(jPH)
<br /> SAFL-*.suCriO,4sYS't*E)4SINoVAI.IJI:si,'4LiLLON,%;GROLNr)PIPIN(,.): SAFE SUC7110,SYSTr-Mq(NO VAI.Vl-%IN BELO*CROOND PIPING)'
<br /> [J-7.11FLITMONTIORINU, 07. SELF MON11OKING,
<br /> GRAVITY FLOW GRAVITY FLOW(Check all 1hjItPPJYI-
<br /> ❑9.BIENNIAI,INTEGRITY TES I.W.I GNI)
<br /> Q A. DAILY VISUAL MUNITOKING
<br /> a 9. MUNNIAL wrEuKrrY'rEST 10.1 GPH)
<br /> SECONDARILY CU.,fAINED PIPING SECDf4pApI1V CONTAINED PIPING
<br /> PI\ESSURI7FT)PIPING Wrkk 311 ilwl aPP0: pRLSSURIZL0 PIPING(Chq:,:k*It 1h.1 ajq,ly)
<br /> to. CON'rINIXILIS TURRINE SUMP S M- SOK AL W AUninf.r.AND VISUAL 10. CONTINUOUS
<br /> TURBINE)SUMP SENSOR WIT!!AIJDinf.E AND VISUAL
<br /> ALARM.S ANT)Wh-1--
<br /> ALARMS AND 1(:Wk unel , AU IU PUMP SHUT(:)FF wi rI7.N A LFAK OCCURS
<br /> [],I. AlfTOPI).Mll'illL*I'OFF WHFNAI-F,\KoCCUR�i ❑b AUTO PCMI1 SHUT OFF FOR,J,FAKS,.qYSTr.M VAILURE.ANDSYsTIJ,1
<br /> Elb. AUTO PI IMP 1.;IIIjT OFF'ItOR LEAKS,SYSTEM FAILLIKLANI.)SYSTEM ❑ Li)S(.rjNNFCTI0N
<br /> DISCONNECTION 0,: NO AUTO pUMpcnUT orr
<br /> Oc. NO AUTO PUMP SHUT OFF
<br /> 11. AUTOMATIC I,jNr. i.r..AK DIjEc 1-OK 11.0 GPH TEST)Wil.H FLOW SHUT 0 11. AUT(.)MATIC.LEAK DF.TECTOR
<br /> orr OR KESTKKA ION❑ [I Q. ANNUAL IN'feGfUTY TEST(0.1 CPN)17.. ANNUAL INTEGRITY TES I-IVA GPH)
<br /> SUCTIONAiRAVI'l Y SYSTEM
<br /> SUL7TIt-)V/(,RAVrTY%YSTENI 0 13. awl'INUOLS SUMP SENSOR-AUDIDIX AND VISUAL ALARMS
<br /> ❑13. CQNTINI IOUs SUMP SENSOR+AUDIALF AND VISUAL ALAILYS k:MEKGExCV(;VNEIR.A.TORS ON LY tt:heck-11 that 3PPIV)
<br /> r.NtFR(;ENCy GcI%1�1c#,TORS ONLY((:heck all thil WIV
<br /> ❑14. CONTINUOUS SUMP ST-,Iq"(.)R WIT11101A AUTO PUMP SIR3T OFF• [3 1-3. CONTIN1,101 ISSUMPSLNSOK Will FIOVT AUTO PUMP Sf1UT OFF
<br /> AUDIBLE AND VISUAL At-ARMS 1Lt,'I31I3LE AND VISUAL ALARMS
<br /> E115, AUTOMATIC LINE LEAK ObTECTOR(1.0GPH TEST)WITHOIJ FI-OW 0 15.AVIOMArtC LINE LEAK nr.Ti-r.ToR(10(;Pit TEST)
<br /> SHUT OFF OR RESTRICTION jj 16.ANNUAL IN*IEGKI'l Y TEST(0 10PID
<br /> 0 16.ANNLIAL INTF:(;RITY TES r(1),I GPH) C3 17- DAILY VISUAL CHECK
<br /> ❑il. DAILY VISUALCHE'LK.
<br /> Vill.DISPI ('ONTAINNIENT
<br /> DISPENSEK.CONTAINNIFNT ❑I.rLOA1'r-4ECHANI1,M TIIAT SHUTS OFF SHEAR VALVF D<.DAILY VISUAL CHECK
<br /> DATLLNSTALLEL) 2.CONTINUOUS VISPFNsrR PAN SENSOR AUDIBLE AND VISI RAI.ALARMS A S.TRENCH LINER!MONIT(MING
<br /> NSF T OFF FOR [3&NONL 469
<br /> ❑3 CONTINUOUS L)ISPb p DAN Sr.NSOR WiTtl ALTO SHUT'Adf RISPE.,�SFR AIIDIULE AND VISUAL_At-ARM-9 __.___ -
<br /> IX.OWNEWOPERATOR SIGNATU RV
<br /> llk!og.ral,on provided here is wt its,
<br /> I-tify 4h"I;� .. - - bct of my knkllu: r)ATF 470
<br /> SI- U OF�OW",oER;O -.R 3 10h 3
<br /> 'U 6F'O""'
<br /> 471 TITLE. OF0W14r.RJGPI.:RATQK
<br /> RiOPf PT
<br /> M�E%-WINLkl5P AT Int)
<br /> A4 Pbd AMmed ror local u:e On- wien Dow Il'o,
<br /> Peron munftr(For local um(-IYI 47)
<br /> UPCF(12199 revised) Formerly SWRCB Komi B
<br />
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