BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

✓IFIED PROGRAM CONSOLIDATED FORM� 3/0/ TANK: TA0133(103 PR#: PRO231330 UNDERGROUND STORAGE TANKS - TANK PAGE 2 FAC#: FA0003964 VI.PIPING CONSTRUCTION(ch x w mat apply) Page 3 ors UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE I.PRESSURE [12.SUCTION ❑3.GRAVFFY 458 ❑ L PRESSURE [:12.SUCTION ❑3.GRAVITY 459 CON57Rucrlm ❑❑��I SINGLE WALL ❑3.LINED TRENCH El".OTHER W El 1.SINGLE WALL ❑ 95.UNKNOWN 462 (�2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461 MANUFACTURER 465 ❑ I.BARE STEEL ❑6.FRP COMPATIBLE wl loo.METHANOL ❑ LBARESTEEL ❑ 6.FRPCOMPATIELEwllo9 WTHANOL ❑2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑PLASTIC COMPATIBLE W/CONTENTS El 95.UNKNOWN El PLASTIC COMPATIBLE W/CONTENTS El 9s.UNKNOWN •h-AJI.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER ❑4.FIBERGLASS ❑ B.FLEXIBLE(HDPE) ❑ 99.OTHER ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 4M [15.STEEL W/COATING ❑9.CATHODIC PROTECTION 465 VII.PIPING LEAK DETECTION(cI 4 wn a Jy)U 6m�pEos ormemo,,;�m6, patPm,,,Iwlro.:,.6,,,;udlmtx lo.,l,aaay) UNDERGROUND PING ABOVEGROUND PIPING SINGLE WALL PIPING asb SINGLE WALL PIPING 467 PRESSURIZED PING(Check W that appy): PRESSURIZED PIPING(Check all that apply): ❑ I.ELECTRONIC LME LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDE3LE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑2.MONTHLY 01 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 2.MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIF.AL 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(V0 VALUES IN BELOW GROUNDPIPING): E] 7.SELF MONITORING GRAVITY FLOW [17.SELF MONITORING ❑9.B@NNW.INTEGRITY TEST(0.1)GPH GRAVITY FLOW(Check all that apply): [18.DAILY VISUAL MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check a8 that apply): PRESSURIZED PIPING(Check a8 that apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMSAND(C kws) ALARMS AND(C6eak ms) ❑a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b.AUTO PIMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ b.AUTO PUMP SHIFT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ZfSCONNECT10N DISCONNECTION NO AUTO PUMP SHUT OFF ❑ C.NO AUTO PUMP SHUT OFF �1M AUTOMATIC LE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTR11.AUTOMATIC LEAK DETECTOR 12.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVTTY SYSTEM ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Clark all m t appy) EMERGENCY GENERATORS ONLY(Cha&all mat appy) ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF" ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF" AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS El 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW E] 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.I GPH) ❑ 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK Vm.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1,FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL CHECK DATE INSTALLED 468 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑f�TRENCH LRJF.R/MONITORING E]3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 6.NONE DISPENSER+AUDIBLE AND VISUAL ALARMS 469 IX.OWNER/OPERATOR SIGNATURE I w4Fy mat da mF tioopmvidNlvonubuc and to mthe 6®t otmylmowW, SIGNATURE OF OWNER/OPERATOR DATE no NAME OF OWNEWOPERATOR(prim) TITLE OF OWNER/OPERATOR (prim) 471 Pm,Nw (F-1-1 -y) 473 Pmmt Appmved(Fm bael uac®ly) 474 Pm aEVuatim(Nwffw mcy) 475 PT0006610 EE0000817 1/1/1993 UPCF(12/99 revised)