BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

T �JNIFIED PROGRAM CONSOLIDATED FOI, TANK- PR#: FAC#: UNDERGROUND STORAGE TANKS -TANK PAGE z q' ir3 VI.PIPING CONSTRUCTION Pye3 era UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ I.PRESSURE [12-SUCTION ❑ 3.GRAVITY 459 ❑ 1.PRESSURE ❑ 2.SUCTION ❑3.GRAVITY CDNSTRULTION ❑I.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 4a ❑ 1.SINGLE WALL ❑ 95.UNKNOWN 16aM I U/ 02.DOABLE WALL ❑95.UNKNOWN El 2.DOUBLE WALL ❑ 99.OTHER I� MANUFACTURER 461 MANUFACTURER 46I ❑ 1.BARE STEEL ❑ 6.FRP COMPATIBLE w/IaXMETRANOL ❑ 1.BARE STEEL ❑ 6.FRP COMPATIBLE wY lay.METHANOL ❑2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN ❑4.FIBERGLASS ❑S.FLEXIBLE(HOPE) ❑ 99.OTHER ❑ 4.FIBERGLASS ❑ B.FLEXIBLE(HOPE) ❑ 99.0THER ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION a64 ❑ 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION MS VII.PIPING LEAK DETECTION(OhaAa tiotappy)(A aeavipllan often m9nimringprugamstep hesace:adwm.wdy y.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Cheek W that apply): PRESSURIZED PIPING(Check all that apply); ❑ I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE.AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION,AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH TEST - ❑ 3.MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 4.DALLY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) [IS.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING ❑ 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) ❑6.TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑7.SELF MONITORING ❑ 7.SELF MONITORING GRAVITY FLOW ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH GRAVITY FLOW(Cheek ell tbat apply): ❑ S.DAILY VISUAL MONITORING ❑ 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 WIT F AUDIBLEANDVISUAL ALARMSAND(C me) ALARMS AND(Cheek onc) ❑ 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 ❑e.NO AUTO PUMP SHUT OFF ❑ C.NO AUTO PUMP SHUT OFF ❑ 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPU) ❑ 12.ANNUAL INTEGRITY TEST(0.1 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(Clickat tont appy) EMERGENCY GENERATORS ONLY(Q dl mat appy) ❑ IC CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION SENT OFF OR RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17.DALLY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK VDI.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1,FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4.DALLY VISUAL CHECK DATE INSTALLED 469 2.CONTINUOUS DISPENSER PAN SENSOR AND VISUAL ALARMS ❑ ❑ 5.TRENCH LINER/MONITORING ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WIT AUTO SHUT OFF FOR ❑ 6.NONE DISPENSER+AUDIBLE AND VISUAL ALARMS 469 IX.OWNER/OPERATOR SIGNATURE I mtiy then the htfmmedce pn raaea mem is nee n aaa tele w the het any kmnledle. SIGNATURE OF OWNER/OPERATOR DATE 470 NAME OF OWNER/OPEJWTOR(print) TITLE OF OWNER/OP TOR Pemit Nnnbe(Pebolueetly) 473 Pemit Appy-W(Fe local we only) 474 Perta[8 pbaaon Mw(Pebd uepay) 475 UPCF(12/99 revised)