Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> P NG=C"ON b 70 _ Pae of <br /> UNDERGROUND PIPING N.k^hae,l ik6i;' I <br /> SYSTEM 7YP6 01.pl---REABOVEGROUND PIPING <br /> CONSTRUCTION/ SUCTION 0 3.GRAVITY 45a. <br /> MANUFACTURER .Ia'rSD'IGLE WALL 0 3.LINED TRENCH ❑I.PRESSURE SUCTION C]3.GRAVITY 459. <br /> 02.DOUBLE WALL 099.OTHER 460. 1.SMGLE WALL <br /> ❑95.UNKNOWN ❑95.UNKNOWN 163. <br /> MANUFACTURER 0 2.DOUBLE WALL 0 99.OTHER <br /> �BARESTEEL 06.FRP COMPATIBLE W/100%METHANOL L61 MAN <br /> 2. UFACTURIR <br /> STAINLESS STEEL 0Y.BARE STEEL 463. <br /> ❑7.GALVANIZED STEEL ❑6.FRP COMPATIBLE W1111111 ETHANOL <br /> 0 3.PLASTIC COMPATIBLE WITH CONTENTS 0 2.STAINLESS STEEL <br /> ❑95.UNKNOWN 03,PLASTIC COMPATIBLE W/CONTENTS 0S CALVBNIZED STEEL <br /> LE(HOPE) <br /> 0 4.FIBERGLASS ❑e.FLEXIBLE(HDPE) ❑99.OTHER 0 4.FIBERGLASS 0 9.FLEXIBLE(HDPE) 0 99.OTHER <br /> ❑S.STEEL W/Cpg77NG ❑9.CgTHODIC PROTECTION 464. ❑9.CATHODIC PROTECTION <br /> VTI:F ❑S STEEL W/COATING 0 95.UNKNOWN <br /> ]Nlni- AIftDP„"PE�ION enerk.0 tnac I Aeeed6ehenna moo@orJn m 465. <br /> UNDERGROUND PIPING +m:hal'''?sabm%t0.,ttl4h'161encI <br /> 44 <br /> SINGLE WALL PIPING ABovEcftotIND PIFING <br /> PRESSURIZED PIPING(Check all that apply), 466, SINGLE WALL PIPING <br /> 0 1. ELECTRONIC LINE LEAK DETECTORPP Y) PRESSURIZED PIPING(Check all that a l 67 <br /> SHUT-OFF FOR LE E,3. ANOPHD <br /> TEST DIS ONTO PUMP ❑1, ELECTRONIC LINE LEAK DETECTOR 3,0 OPH TEST W <br /> +AUDIBLE AND VISUAL ALARMS(LURE'OND SYSTEM DISCONNECTION SHUTOFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DAUTO PUMP <br /> ISCONNECTION <br /> 112 MONTHLY 0.2 GPH TEST +AUDIBLE AND VISUAL ALARMS <br /> O 3. ANNUAL INTEGRITY TEST(0.1 GPH) -/ 02. MONTHLY 0.2 GPH TEST <br /> ❑3., ANNUAL MTEGRITY TEST(0.I OPH) <br /> CONVENTIONAL SUCTION SYSTEMS 04. DAILY VISUAL CHECK <br /> 0 5. DAILY VISUAL MONITORING OF PUMPING <br /> SYSTEM NNIAL PIPING <br /> SUCTION SYSTEMS(Check all that apply) <br /> INTEGRITY TEST(0.1 GPH) <br /> ❑S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> 07. SELF MONITORING 06, TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> GRAVITY FLOW SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> 09. BIENNIAL INTEGRITY TEST(0.I OPH) 07. SELFMONITORING <br /> GRAVITY FLOW(Check all that apply): <br /> 08- DAILY VISUAL MONITORING <br /> SECONDARILY CONTAINED PIPING 09. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> PRESSURIZED PIPING(Check all theta I SECONDARILY CONTAINED PIPING <br /> 10. CONTINUOUS TURBINE SUMP SENSOR PRESSURIZED PIPING(Check all that e 1 <br /> ALA RMS AND(Check ora) Y(U'1I AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> O a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ALARMS AND(Check ane) <br /> 0 b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 4 AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> DISCONNECTION ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> Cc. NO AUTO PUMPSHUTOFF DISCONNECTION <br /> 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SNOT Oc, NO AUTO PUMP SHUT OFF <br /> OFF OR RESTRICTION CII.AUTOMATIC LEAK DETECTOR <br /> 012. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM �(/ 012.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS SUCTION/GRAVITY SYSTEM <br /> EMERGENCY GENERATORS ONLY(Check all that• 1Y) 0 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> 0 14. CONTINUOUS SUMP SENSOR EMERGENCY GENERATORS ONLY(Check all that apply) <br /> AUDIBLE AND VISUAL ALARM AUTOO PUMP SHUTOFF 0 14. CONTINUOUS SUMP SENSOR <br /> 015. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) T FLOW AUDIBLE AND VISUAL ALAR MM AUTOPUMPSHUTOFF <br /> SHUT'OFF T RESTRICTION W IWV 0 I5. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> ❑I6. ANNUAL INTEGRITY TFS7(0.1 GPH) <br /> 017. DAILY VIS UAL CHECK 016. ANNUAL INTEGRITY TEST(0.1 OPH) <br /> 17. DAILY VISUAL CHECK <br /> DISPENSER CONTAINMENT <br /> ❑1. FLOAT MECHANISM THAT SHUTS OIF SHEAR VALVE <br /> DATE INSTALL 02. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL AEFORid <br /> DAILY VISUAL CHECK 469 <br /> 03. CONTINUOUS DISPENSER PAN SENSOR TRENCWLMER MONITORING <br /> DISPENSER+AUDIBLE AND VISUAL ALARM AUTO SHUT ONONE <br /> I ceni that the info - - N 4)Y4.87[(it�'A"I1C1I�E,fY ovided ein is We an accu eto thbof my knowledge. <br /> ATUREOFOWN O TOR <br /> Ora.NAMEOFOWNER/OPERATOR(p' TITLE OFOWNER/OPERATOR: OttPesnut Numher(Agency473. PennilAppmvedHY(AgPee(Agency use oNY) ns. <br /> UPCF hwfwrc-b(1/99)-3/4 http://Www.unidoc&org <br /> Rev.02/16/00 <br />