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UNDERGROUND STORAGE TANKS-TANK PAGE 2 <br /> Page of <br /> VI.PIPING CONSTRUCTION(chackell thm <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE L PRESSURE D 2.SUCTION D 3.GRAVITY 458. 1 D 1.PRESSURE D 2.SUCTION D 3.GRAVITY 459. <br /> CONSTRUCTION/ D 1.SINGLE WALL ❑3.LINED TRENCH D 99.OTHER 460. D I.SINGLE WALL D 95.UNKNOWN 462, <br /> MANUFACTURER 2.DOUBLE WALL D 95.UNKNOWN D 2.DOUBLE WALL D 99.OTHER <br /> MANUFACTURER 461. MANUFACTURER 463. <br /> D 1.BARE STEEL D 6.FRP COMPATIBLE W/100%METHANOL D 1.BARE STEEL D 6.FRP COMPATIBLE W/100%METHANOL <br /> ❑2.STAINLESS STEEL [17.GALVANIZED STEEL D 2.STAINLESS STEEL D 7.GALVANIZED STEEL <br /> D 3.PLASTIC COMPATIBLE WITH CONTENTS D 95.UNKNOWN D 3.PLASTIC COMPATIBLE W/CONTENTS D 8.FLEXIBLE(HDPE) ❑99.OTHER <br /> D 4.FIBERGLASS ❑S.FLEXIBLE(HDPE) ❑99.OTHER D 4.FIBERGLASS D 9.CATHODIC PROTECTION <br /> 5.STEEL W/COATING D 9.CATHODIC PROTECTION 464. D 5.STEEL W/COATING D 95.UNKNOWN 465. <br /> VII:PIPING LEAK DETECTIONICh wihata ty)(A descrilionoft"om '`s Rbesubrnla rothlm1 agency.) .: <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING SINGLE WALL PIPING 467. <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST=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 /> [12. MONTHLY 0.2 GPH TEST [12. 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 SUCIION SYSTEMS(Check all that apply) <br /> ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING [35, DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> D 7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLAW ❑7. SELFMONITORING <br /> [39. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): <br /> ❑8. DAILY VISUAL MONITORING <br /> [19, 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 ane) <br /> a. AUTO PUMP SEM'OFF WHEN A LEAK OCCURS D a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> ❑b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM D b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTIONDISCONNECTION <br /> Dc. NO AUTO PUMP SHUT OFF Dc. NO AUTO PUMP SHUT OFF <br /> ❑ <br /> 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)MM FLOW SHUT 11.AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) D 12.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> [114. CONTINUOUS SUMP SENSOR WITH AUTO PUMP SHUT OFF D 14.CONTINUOUS SUMP SENSOR WITH AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> ❑15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW [115.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> [116. ANNUAL INTEGRITY TEST(0.1 GPH [116.ANNUAL INTEGRITY TEST(0.1 GPH) , <br /> [117. DAILY VISUAL CHECK D 17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 468. D 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04. DAILY VISUAL CHECK 469. <br /> DATE INSTALLED . CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [15. TRENCHILINER MONITORING <br /> D 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 06. NONE <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> M OWNER/OPERATOR SIGNATURE <br /> I certify that the information provided herein is hue and accurate to the best of my knowledge. <br /> SIGNA O TORDATE: 470. <br /> NAME <br /> R/ PE ( _ OF OWNER/OPERATOR: 4M <br /> Permit Number(Agency use only) 473. Permit Approved By(Agency use only) 474. 1 Permit Expiration Date(Agency use only) n5. <br /> 63 <br />