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UNIFIED PROGRAM CONSOLIDATED FORM ETAN UNDERGROUND STORAGE TANKS-TANK PAGE 2 VI.PIPING CONSTRUCTION[Chock aNOW&PW UNDERGROUNO PIPING ABOVEGROUND PIPING SYSTEM TYPE PRESSURE ❑ 2_SUCTION ❑ 3 GRAVITY ❑ 1. PRESSURE ❑2.SUCTION ❑ 3. GRAVITY CONSTRUCTION! ❑ t SINGLE WALL 1--] 3. LINEO TRENCH ❑89 OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER 1 DOUBLE WALL ❑95. UNKNOWN ❑ 2 DOUBLE WAIL ❑99. OTHER NUFACTURER MANUFACTURER ❑ 1 BARE STEEL ❑ 6 FRP COMPATIBLE W1100%METHANOL ❑ 1.BARE STEEL ❑ 6 FRP COMPATIBLE Wl 100%METHANOL MATERIALS AND ❑ 2.STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7 GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95 UNKNOWN ❑ 3 PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE(HDPE) ❑S9. OTHER 4 FIBERGLASS ❑ B. FLEXIBLE(HDPE) ❑99. OTHER ❑ 4 FIBERGLASS ❑ 0 CATHODIC PROTECTION ❑ 3 STEEL W!COATING ❑ 9.CATHODIC PROTECTION ❑ 5 STEEL WN COATING ❑95. UNKNOWN VI I.PIPING LEAK DETECTION(Check AR fhef xp*) 4NOERGROUND PIPING ASOVEGROUNO PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING{Check AA Thal►poky? PRESSURIZED PIPING(Check au that appry) ❑ 1. ELECTRONIC LINE.LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3 0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. LEAK.SYSTEM FAILURE.ANO SYSTEM DISCONNECTION.AUDIBLE AP40 VISUAL SYSTEM FAILURE,AMC SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2 MONTHLY 0.2 GPH TEST ❑ 2 MONTHLY G 2 GPH TEST ❑ 3 ANNUAL INTEGRITY TEST(0.1 GPH( ❑ 3 ANNUAL INTEGRITY TEST(G.1 GPH) ❑ 4, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS(Check Ad fhet aPPIVY CONVENTIONAL SUCTION SYSTEMS" ❑ 5 Doi VISUAL MONITORING OF PUMPING SYSTEM-TRi ENNI AL PIPING INTEGRITY ❑ 5 DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM AI TEST(0 f GPH] ❑ 6 TRIENNIAL INTEGRITY TEST 0.1 GPH} SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) SAFE SUCTION SYSTEMS INO VALVES IN BELOW GROUND PIPINGi ❑ 7 SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW{Check A!I that epPW ❑ 9 BIENNIAL INTEGRITY TEST(0 1 GPHj ❑ 6. DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GPH( SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check ah that 41)#Y) PRESSURIZED PIPING(Check ail that ePPM: to. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10.CONTI NVOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS A N 0(check anal icneck any ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS NICK- AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM © E AUTO PUMP SHUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF ❑ G NO AUTO RUMP SHUT OFF 11 AUTOMATIC LINE LEAK DETECTOR 13 0 GPH TEST]Vu1TH FLOW SHUT OFF OR ❑ 11.AuTomxTIC LEAK DETECTOR RESTRICTION ❑ 12 ANNUAL INTEGRITY TEST(C 1 GPH] ❑ 12 ANNUAL INTEGRITY TEST;0.1 GPH] SUCTIONIGRAVITY SYSTEM: SUCTIONIGRAVITY SYST'-W ❑ 13 CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS ❑ 13 CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY{Check Ab d+af APOY) EMERGENCY GENERATORS ONLY(Chw*Alt OW RAW ❑ 14 CONTINUOUS SUMP SENSOR VNTHOUT AUTO PUMP SHUTOFF+AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15 AUTOMATIC LINE LEAK DETECTOR 13.0 GPH TEST]WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST] RESTRICTION ❑ Ia.ANN°JAL INTEGRITY TEST i0.1 GPH] ❑ 16.ANNUAL INTEGRITY TEST(0 1 GPH] ❑ 17 DAILY VISUAL CHECK ❑ 17 OMLYYISUALCHECK VNI.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SNOTS OFF SHFAR VALVE ❑4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR F AUDIBLE AND VISUAL ALARMS ❑ 5 TRENCK LINER t MGNITORING .CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6- NONE M OWNERIOPERATOR SIGNATURE I perety MAC 61a inlokmation PM-4ded II-OPW Is VUe and eoclsato to&W East of my knowledge SIGMA TUBE OFa WNEWPERATOR DATE NAME OF OWNER,OPERATOR(Pird] TITLE OF OWMERIOPERATOR Psm+11 NomOer{Far 7acaf k,le oMy] P,ww4 APPION (Foram(cats Pnly) Pemvt EaP�tion Dale(For local= CUPAFgRM(4199) Farmerty SVVRCB Farm$