Laserfiche WebLink
MAY 1 1 2Q05 <br /> UNDERGROUND STORAGE TANKS-TANK PAG <br /> nz o Page of <br /> VI.PIPING CONSTRUCTION ICheckati trot I) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 458. ❑1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 459. <br /> CONSTRUCTION/ 0 1.SINGLE WALL 0 3.LINED TRENCH ❑99.OTHER 460. ❑1.SINGLE WALL 0 95.UNKNOWN 462. <br /> MANUFACTURER .DOUBLE WALL 0 95.UNKNOWN ❑2.DOUBLE WALL 0 99.OTHER <br /> MANUFACTURER <br /> 461. MANUFACTURER 463. <br /> 0 1.BARE STEEL 0 6.FRP COMPATIBLE W/100%METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE W/100%METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL [12.STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> [13.PLASTIC COMPATIBLE WITH CONTENTS 0 95.UNKNOWN 0 3.PLASTIC COMPATIBLE W/CONTENTS [18.FLEXIBLE(HDPE) 0 99.OTHER <br /> 0 4.FIBERGLASS 0 8.FLEXIBLE(HDPE) [199.OTHER 0 4.FIBERGLASS [19.CATHODIC PROTECTION <br /> 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464. 0 5.STEEL W/COATING [195.UNKNOWN 465. <br /> -. VIE PIPING LEAK DETECTION(C6eciai tM, t)<Ae ewolme nto tong pro ,h+libecabmacd to tticl«m+ge6ovJ <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466. SINGLE WALL PIPING 467. <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP 0 1. ELECTRONIC LIKE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> SHUT-OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION <br /> +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. <br /> 02. MONTHLY 02 GPH TEST 02. MONTHLY 0.2 GPH TEST <br /> [13. ANNUAL INTEGRITY TEST(0.1 GPH) [13. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING [15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): [36. TRlENNIAL INTEGRITY TEST(0.1 GPH) <br /> [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELF MONITORING <br /> [19. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): <br /> 0 8. DAILY VISUAL MONITORING <br /> 09. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Check one) <br /> Xa. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> Oc. NO AUTO POMP SHUT OFF Oc. NO AUTO PUMP SHUT OFF <br /> ❑ <br /> 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 0 1I AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> [314. CONTINUOUS SUMP SENSOR WITH AUTO PUMP SHUT OFF [114. CONTINUOUS SUMP SENSOR WITH AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> [115. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW 0 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> [116. ANNUAL E-TEGRTfY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) , <br /> [117. DAILY VISUAL CHECK 0 17.DAILY VISUAL CHECK <br /> VIIL DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 468. 0 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04. DAILY VISUAL CHECK 49. <br /> DATE INSTALLED 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 5. TRENCH/LINER MONITORING <br /> 3. CONTINUOUS DISPENSER PAN SENSOR WIT' AUTO SHUT OFF FOR 06. NONE <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> I certify that the information provided herein is me and accurate to the best of my knowledge. <br /> SIGNATURE OF OR DATE: 470. <br /> $=9�S <br /> NAME OF 0 �' RATOR( ( , OF OWNERO TOR' 47i <br /> �/ J <br /> Permit Number(Agency use only) 473. 1 Permit Approved By(Agency use only) 474. 1 Permit Expiration Date(Agency use only) 475. <br /> 63 <br />