BILLING 2001 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION(Check atl Malapplyl UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 ESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ 1. SINGLE WALL ❑ 3. LINED TRENCH 1199 OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER ❑ 2 DOUBLE WALL ❑95. UNKNOWN ❑ Z. DOUBLE WALL [IN OTHER MAN ACTURER MANUFACTURER 1.BARESTEEL ❑ B. FRP COMPATIBLE W1100%METHANOL ❑ 1, BARE STEEL ❑ B. FRPCOMPATIBLEW11W%METIUNOL MATERIALSAND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 0 9. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ e. FLEXIBLE(HDPE) 1199 OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEELW/COATING 1195. UNKNOWN VII.PIPING LEAK DETECTION(CMck 0 fhaNpply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALLPIPING PRESSURIZED PIPING(Check ad Met eppty: PRESSURIZED PIPING(Cmak eN marapply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK. LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM TEST El 2. MONTHLY 0.2 GPM TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3.ANNUAL INTEGRITY TEST lot GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all Nat appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ Z SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW(CMck all Mat apply)' ❑ 9. BIENNIAL INTEGRITY TEST 10.1 GPM) ❑ S. DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that appy): PRESSURIZED PIPING(Check aethal apply): 10.CONTINUOUS TURBINE SUMP SENSOR NTH AUDIBLE AND VISUAL ALARMS AND (Check Dna) 10,CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check am) ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ E AUTO PUMP DISCONNECTIONT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ E, AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NOAUTO PUMP SHUTOFF ❑ c. NO AUTO PUMP SHUTOFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST D 1 GPM) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONIGRAVITY SYSTEM: SUCTIOWGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(CMck eN(hal apply) EMERGENCY GENERATORS ONLY(CMck all(ha(Apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUTAUTO PUMP SHUT OFF-AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITMOUTAUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3 0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 18. ANNUAL INTEGRITY TEST IDA GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK Vill.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATEINSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER I MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WTH AUTO SMUT OFF FOR DISPENSER.AUDIBLE AND VISUAL ALARMS ❑ 9. NONE I%.OWNERIOPERATOR SIGNATURE I cartly Mat Me Wormalion Provided tenon IS MIS and a=mn 0 tM East of my on ad9a. SIGNATURE OF OWNER(OPERATOR DATE NAME OF OWNERIOPERATOR RWRI TIRE OF OWHERIOPERATOR Permit NumEer(For.at uss oMy) Permit Appmved(ForkKal use Dory) Pamtil ESPiradan Dan(Forlocal..eny) CUPAFORM(0199) • • Formerly SWRCB Form B