BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 Pae of VL PIPING CONSTRUCTION tOweeka that -- UNDERGROUND PIPING I .ABOVEGROUND PIPING SYSTEM TYPE ❑1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 458. 111.PRESSURE 0 2.SUCTION 0 GRAVITY 459, CONSTRUCTION/ 0 L SINGLE WALL MANUFACPURER (]3.LINED TRENCH ❑99.OTHER 469. ❑1.SINGLE WALL ❑95.UNKNOWN NOWN 4662Z ❑2.DOABLE WALL [195.UNKNOWN ❑2.DOUBLE WALL 0 99.OTHER MANUFACTURER 461. MANUFACTURER 463. 0 1.BARE STEEL [16.FRP COMPATIBLE W/I 00%METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE W/I 00%METHANOL 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 2.STAINLESS STEEL [17.GALVANIZED STEEL 0 3.PLASTIC COMPATIBLE WITH CONTENTS [195.UNKNOWN [13.PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPE) ❑99.OTHER 0 4.FIBERGLASS [18.FLEXIBLE(HDPE) 0 99.OTHER [14.FIBERGLASS ❑9.CATHODIC PROTECTION 0 5.STEEL W/COATING [19.CATHODIC PROTECTION 464. 0 5.STEEL W/COATING ❑95.UNKNOWN 465. VA PIPINGEkAKDETECTION{Check ellthwaptaiii,fA, ftlw encereveraceace.ballba a cbmktedbtkrlaoil UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING K6. SINGLE WALL PIPING 467, PRESSURIZED PIPING(Check a0 that apply): PRESSURIZED PIPING(Check all thatapply): 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP [11. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT-OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. [12. MONTHLY 0.2 GPM TEST [12. MONTHLY 0.2 GPM TEST [13. ANNUAL INTEGRITY TEST(0.1 GPM [13. ANNUAL INTEGRITY TEST(0.1 GPM) [:14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑ S. DALLY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING [35. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) 0 7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELFMONITORING [19. BIENNIAL INTEGRITY TEST(0.1 GPM) GRAVITY FLOW(Chat all that apply): 0 8. DAILY VISUAL MONITORING 09. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARD,Y CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all shat apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check am) ALARMS AND(Check am) ❑a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 h.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION On. NO AUTO PUMP SHUT OFF Oc. NO AUTO PUMP SHUT OFF ❑11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT 0 OFF OR RESTRICTION 11. AUTOMATIC LEAKDETECTOR ❑12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL ALARMS 013.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chat all that apply) EMERGENCY GENERATORS ONLY(Check all dut apply) 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS [115. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) [116. ANNUAL INTEGRITY TEST(0.1 GPM) 0 16. ANNUAL INTEGRITY TEST(0.1 GPM) 017. DAILY VISUAL CHECK 017, DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT. DISPENSER CONTAINMENT468. ❑I. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE []4. DAILY VISUAL CHECK 469. DATE INSTALLED 02. CONTINUOUS DISPENSER PAN SENSOR«AUDIBLE AND VISUAL ALARh1S [35. TRENCH/LINER MONITORING 03. CONTINUOUS DISPENSER PAIN SENSOR WITH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑6. NONE IC.OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and actuate to the best of my knowledge. SIGNATURE OF O ER/OP T, DATE: O ` 470. NAME OF OKeiko SIT;n Mo+o WNER/OPERATOR(print): TITLE OF/OWNER/OPERATOR: 4n Tint Number(Aeemy.only) 473. Permit Approved By(Agency uaa only) 474. 1 Permit Expiration Data(Agency use only) 475. UPCF hwflvrc-h(1/99)-3/4 http://www.midoo.org Rev.02/16/00