BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 Pa e_of_ VL PIPING CONSTRUCTION cnrcken wta ) ABOVEGROUND PIPING UNDERGROUND PIPING ass. SYSTEM TYPE .PRESSURE ❑2.SUCTION [33.GRAVITY 458. ❑1.PRESSURE ❑2.SUCTION [13.GRAVITY Obi. C NSTRUCTION/ [31.SINGLE WALL ❑3.LINED TRENCH [399.OTHER 460. ❑1.SINGLE WALL ❑95.UNKNOWN MANUFACTURER pj�,DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER 461. MANUFACTURER 463. MANUFACTURER ❑6.ERP COMPATIBLE W/IOOWo METHANOL ❑1.BARE STEEL C3 6.FRP COMPATIBLE w/100%METHANOL ❑1.BARE STEEL 7,GALVANIZED STEEL [32.STAINLESS STEEL [37.GALVANIZED STEEL ❑ STAINLESS2.STALESS STEEL [3 ❑3.PLASTIC COMPATIBLE WITH CONTENTS ❑95.UNKNOWN [33.PLASTIC COMPATIBLE W/CONTENTS' O 9.CATHIBL(PROTECTION ❑99.OTHER [14.FIBERGLASS P'FLEXIBLE(HDPE) 1399.OTHER ❑4.FIBERGLASS ❑ 464. 95.UNKNOWN [35.STEEL W/COATING ❑9.CATHODIC PROTECTION ❑S.STEEL W/COATING _ VIL PIPING LEAK DETECTION(eneetamnm ) A6ecd tma ortne moanod mmm vhelAI BOVEGROUND PIPING ) UNDERGROUND PIPING 46]. SINGLE WALL PIPING 466. SINGLE WALL PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): AUTO PUMP ❑1 ELECTRONIC DETECTOR TEST W-JH AUTO PUMP ❑1 ELECTRONIC NELEAK DETECTOR 3. SECTION SHUT O FOR LEAK SYSTEM FAILURE,AN SYSTEM DISCONNECTION FE FOR IEA ,SYSTEM AND SYSTEM DISCONN +AUDIBLE AND VISUAL ALARMS. +AUDIBLE RMS. _ [12. MONTHLY 0.2 GVH TEST ❑2. MONTHLY 0.2 GPH TEST [13. ANNUAL INTEGRITY TEST(0.1 GPH) ❑3. ANNUAL INTEGRITY TEST(0.1 GPH) ❑q DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) [35. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING ❑5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(No VALVES IN BELOW GROUND PIPING) SAFE SUUCTON SYSTEMS(NO VALVES IRIENNIAL INTEGRITY TEST(0.1 IN BELOW GROUND PIPING): ❑7. SELF MONITORING ❑'/. SELF MONITORING GRAVITY FLAW GRAVITY FLOW(Check all that apply): ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) []g. DAILY VISUAL MONITORING [19. 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 AND TURBINECheck SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMALARMS AND(Check one) [I 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. D AUTO OPUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ION DISCONNECTION On. NO AUTO PUMP SHUT OFF [1c. NO AUTO PUMP SHUT OFF OLI1. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 011 AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ❑12. ANNUAL INTEGRITY TEST(O.I GPH) [112. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ ERGE13. NCY GENRATORSUOUS SUMP NSOA+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check dl that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF ❑14'CONTINUOUS UDI AUDIBLE ANDSVISUAL AUMP LARMS WITHOUTOR AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS [:115. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) W H T FLOW ❑IS AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION ❑16, p1.R•7UAL INTEGRITY TEST(0.1 GPH) ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑17.DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK ISM DISPENSER CONTAINMENT =FOR ECK 469. DISPENSER CONTAINMENT 46a. ❑1. FLOAT MECHANISM THAT SHUTS OFF SHE VALVE DATE INSTALLED 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ANITORING [33, CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OATOSIATOR SIGNATURE I amity that the information provided herein is true and accurate to the best of mY knoWledge. G4]aDATE: Z 0Z� SIGNA EOF WN ER TOR s (, m_. TITLE OF OWNER/OPERATOR: NAME OFOWNER/OPERATOR(print. Pemti[Number(Agency use only) 473. Permit Approved BY(Agency use only) 4]a. Permit Ezpiretion Date(Agercy use only) 475. Rev.02/16/00 UPCF hwfwrc-b(1/99)-314 http://www.unidocs.org