BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UMMD PROGRAM CONSOLIDATED FORWI TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all chat, 1) Page-of- UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE grl.PRESSURE ❑2.SUCTION ❑3.GRAVITY 453 ❑ I.PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 CONSTRUCTION ❑1.SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 460 ❑1.SINGLE WALL ❑95.UNKNOWN 461 MANUFAcTuuR 0 2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461 MANUFACTURER 463 ❑I.BARE STEEL 14 6.FRP COMPATIBLE W/IWX METHANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE WflW METHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL I ❑Colo... ❑2. STAINLESS STEEL [17.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑99. Other (33. PLASTIC COMPATIBLE W/CONTENTS ❑S.FLEXIBLE(HDPE) ❑99. OTHER ❑4.FIBERGLASS ❑1.FLEXIBLE(HDPE) [14. FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION ab4 [IS. STEEL W/COATING ❑95.UNKNOWN 465 VII.PIPING LEAK DETECTION Check all de, 1)(A dna 'on of the oxxtivaring progrun,hall be aubmieed to the lad UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all dut apply): PRESSURIZED PIPING(Cheek all dw apply): ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.IGPM ❑3.ANNUAL INTEGRITY TEST(0.1GPM ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Cheek 91 dam apply) ❑5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING [15. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPH) [17.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7. SELF MONITORING [19.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Cheek W that apply): Cl 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(Cheek all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check we) ALAR.MS AND(Geek ane) &a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b. AUTO PUMP SHIIT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION 13c. NO AUTO PUMP SHUT OFF Oc 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 GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPM SUCTION/GRAVITY SYSTEM SUCTIONiGRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUALALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Cheek all drat apply) EMERGENCY GENERATORS ONLY(Cheek all that apply) ❑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 ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION [116.ANNUAL INTEGRITY TEST(0.1 GPH) [116.ANNUAL INTEGRITY TEST(0.1 GPH) [317. DAILY VISUAL CHECK [117. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑I.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14.DAILY VISUAL CHECK DATE INSTALLED 469 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING 8/Do ❑1.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR [16.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I certify due the infamadon provided hcrcin 6 ove and accuntc to the but of my knowledge. S `ATURE OF R/OPERA R 4r=,J 'r DATE Fj , O� 470 AME OF OWNERIOPRATO (print) U TITLE OF OWNER/OPERATOR 472 �1/M 60ti1 L� C'UJE lAl�; 0( 1 , j4'GA1 QC-2jF Pemm Number(Far local use,only) 473 Permit Approved(For pod use only) Permit Eapimdoa Date(Far local uu only) 475 UPCF(1/99 revised) 175 Formerly SWRCB Form B