BILLING_2006 - 2008 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 Pae of VI. PIPING CONSTRUCTION (check all that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE '5(1. PRESSURE ❑ 2. SUCTION [13. GRAVITY 458. ❑ 1. PRESSURE ❑ 2. SUCTION [13. GRAVITY 459. CONSTRUCTION/ ❑ I. SINGLE WALL [13. LINED TRENCH [199. OTHER 460. ❑ 1. SINGLE WALL [195. UNKNOWN 462. MANUFACTURER `X2 DOUBLE WALL ❑ 95. UNKNOWN ❑ 2. DOUBLE WALL ❑ 99. OTHER MANUFACTURER SAA (" I}I ' t wpatc s r 461. MANUFACTURER 463. ❑ I. BARE STEEL 196. FRP COMPATIBLE W/100% METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE W/100 METHANOL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL [12. STAINLESS STEEL ❑ 7. GALVANIZED STEEL FI PLASTIC COMPATIBLE WITH CONTENTS ❑ 95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS ❑ 8. FLEXIBLE (HDPE) ❑ 99. OTHER . FIBERGLASS ❑ 8. FLEXIBLE (HDPE) [199. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464. ❑ 5. STEEL W/COATING ❑ 95. UNKNOWN 465, VII. PIPING LEAK DETECTION (Check all that apply) (A descri tion of the monitoring program shall be submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466. SINGLE WALL PIPING 467, PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): ELECTR❑ 1 SHUT-OFF ES STEMSYSTEM ELECTRONIC GPH TEST WITH AUTO PUMP FAILURE, AND S EM D SCONNECTIO N ❑ 1 SHUT LEAK, AK, SYSTEM FAILURE, OFFOR LEAKAND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. + AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST [12. MONTHLY 0.2 GPH TEST [:13. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS (Check all that apply) ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING [15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [16. TRIENNIAL INTEGRITY TEST (0.1 GPH) ❑ 7. SELF MONITORING SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW [17. SELF MONITORING E19. BIENNIAL INTEGRITY TEST (0.1 GPH) GRAVITY FLOW (Check all that apply): [18. DAILY VISUAL MONITORING C]9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ALARMS AND (Check one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS '?,b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑c. NO AUTO PUMP SHUT OFF ❑c. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT ❑ 11. AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) [112. ANNUAL INTEGRITY TEST (0.I GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF ❑ 14. CONTI UOU VISUAL ALARMS WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) SHUT OFF OR RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CFIECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT 468. [:11. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK 469. DATE INSTALLED C32. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH/LINER MONITORING '5i(3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑ 6. NONE DISPENSER+ AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE 1 certify that the infoon provided herein is true and accurate to the best of my knowledge. TA SIGNATURE OF OWN pR DATE: 470' loOCA 472. NAME 0 N�R/�PE `, TIT116R; PRA ' w l -t r -x Permit Number (Agency use only) 473. Perm ^i it Approved By (Agency use only) 474. 7c nitit3Expiration Date (Agency use only) 475. UPCF hwfwrc-b (1/99) - 3/4 http://www.sinidocs.org Rev. 02/16/00