COMPLIANCE INFO_1997-2003 - Laserfiche WebLink

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AWL UNIFIED PROGRAM CONSOLIDATED FORM TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION IChack ah Ilial apply) Page_of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 0 1.PRESSURE 0 2.SUCTION 0 3.GRAVITY 458 01.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 CONSTRUCTION/ 01.SINGLE WALL 0 3.LINED TRENCH 0 99.OTHER 460 01.SINGLE WALL 0 95,UNKNOWN 462 MANUFACTURER 0 2.DOUBLE WALL 0 95.UNKNOWN 0 Z DOUBLE WALL 0 99.OTHER MANUFACTURER Environ 461 MANUFACTURER_ 403 01.BARE STEEL 0 6.FRP COMPATIBLE w/100% MErHANoI 0 1.BARE STEEL 0 6.FRP COMPATIBLE W/100%METHANOL D 2.STAINLESS STEEL 0 7.GALVANIZED STEEL 0 UKNOWN 0 2. STAINLESS STEEL 0 7.GALVANIZED STEEL D 3.PLASTIC COMPATIBLE WI CONTENTS 099. OTHER 03. PLASTIC COMPATIBLE WI CONTENTS 08.FLEXIBLE(HDPE) 099. OTHER ®4.FIBERGLASS 0 8.FLEXIBLE(HOPE) D 4. FIBERGLASS 0 9.CATHODIC PROTECTION 115.STEEL WICOATING 0 9.CATHODIC PROTECTION 464 D 5. STEEL W/COATING D 95.UNKNOWN 465 VII.PIPING LEAK DETECTION(Chark all Iliet apply)(A description of the monito4f;progiam shall be Sabath to the Iorai agetxy.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING)Check a0 Mat applyl. PRESSURIZED PIPING(Check all that apply): ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR 01. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL ALARMS. ALARMS. 0 2. MONTHLY 0.2 GPH TEST D 2. MONTHLY 0.2 GPH TEST ❑3. ANNUAL INTEGRITY TEST(DAGPH) 03. ANNUAL INTEGRITY TEST(0.1GPH) 04. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) 05. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) 05. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) D 7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW [17. SELF MONITORING D9. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): 08. DAILY VISUAL MONITORING 09. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Chad,all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) (Che:kone) 0a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Ob. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM Ob AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION mc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF ®11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUTOFF OR RESTRICTION ❑11 AUTOMATIC LEAK DETECTOR 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) 012. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS VISUAL ALARMS 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR 015. AUTOMATIC UNE LEAK DETECTOR 3 0 GPH TEST RESTRICTION ( ) 0 16. ANNUAL INTEGRITY TEST(0.1 GPH) 016. ANNUAL INTEGRITY TEST(0.1 GPH) D 17. DAILY VISUAL CHECK [117, DAILY VISUAL CHECK VIII:DISPENSER CONTAINMENT DISPENSER 01. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE CONTAINMENT ❑4.DAILY VISUAL CHECK DATEINSTALLED 468 02. CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS 05.TRENCH LINER I MONITORING 1997 ®3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+ 06.NONE 469 BLE AND VISUAL ALARMS IX.OWNERIOPERATOR SIGNATURE I cerldy Nat th to ation provided h ein is a and a=rate to the best of my knowledge. SIGNA F' DATE 470 NAM FOW WUPRAT (print) TITLE OF OVOIEMPERATOR 472 Randy Martin Environmental Manager Permit Number(For local use only) 473 Permit Approved For local use only) Peemit Expiration Dale(For local use only) 475 UPCF(1/99 revised) Formerly SWRCB Form B