Laserfiche WebLink
06/01/2007 22:54 12099549052 ALL INJURY CLINICJG PAGE 05/09 <br /> I r <br /> UNIFIED PROGRAM C SOLIDATED FORM TAMM <br /> UNDERGROUND STORAGEG TANKS-TANK pA GE a ai <br /> VL co It oN' . <br /> AEOVEOROUND P1P4NC' <br /> UNDERGROUND PIP1N0 "O <br /> SYS7LMTYPE .PRZ54VLig ❑7.SUCTION Q3.GRAVT(Y OI,.PRISSUR6 Ql•SuCT[ON 95.UN <br /> VTTY <br /> ' p=,$R901•E WALL <br /> CONSTRPCI N ❑1,SINGLE WALL ❑S.LINED 7RENCII ❑99.00HFIF ❑2 DOUBLE WAW ❑99.OTHER <br /> } UFAC,VMp2-DOUIILEWALL Cln,UNKNO" MANUlAC IRER .63 <br /> MANUPACMIIIp 6.lRP COMPATISLE <br /> SAA wnONIMEDIANDL <br /> ❑6• COM ATIBBI w/19PA M An0L Q I.B Srml- ❑7.GALVANVIED STEEL <br /> C3 2.BTAR°LESS <br /> ❑U, LE99 8TEF3 Q 7.OALYMNIZI3I`+TEFL O la101oAn ❑1 ST SSTEEL <br /> ❑g,PLAS'17C CCMPATCUZ Wl CONTEXTS ❑9P, OIL, 05, C COMPATIBLE W,COMFA IS O _ OTHER <br /> 9 CATHODIC PROT£ N <br /> �a.FISF3OLASS ❑a.fLVMLE(HDPE) ba r GLASS <br /> ` LWICOATINGTJl'RCHOwhI <br /> 0 f.STF£L WKOATINO (]a.CATHODIC PR07IIClTON 9E° ❑t- m loon 10.4 <br /> V]1.P G K BTEC ON xI ( GROUND <br /> U <br /> ub STNGLR W ALL PIP1Nc <br /> SINGLE WALL PIPING <br /> rRESSUR12EG PIPING(CSedA DVFJC AUTO PUMP <br /> I pRSSSURTEHD P PING swap RR Wdr); TEST <br /> aI.ELECTRONIC UNE LEAK DETECTOR 3a GPM Tlm7gDA1 AUTO rUMP SHUT i Q1 gplft RONICI KSKvSTEINPnILVR AND SVST�RMD[SCONNECTTON� <br /> OPP POR LPAK SYSTEM FAILUM AND SYSTEM DISCONNECTION f AUDRILB AND Y)$UAL ALARMS. <br /> AVDIRLH AND VISUAL ALARMS. ( []S MONTHLY Da GMM TEST <br /> ❑I MONrtD•Y"OPHTEST D 3.ANNUAL IN T OPITY TFSY(0`GM <br /> ❑',ANNUAL INTIIDRITY TEST("Co") <br /> ❑°, DAILY vtcUAL CHECK <br /> CONVlNT1dHAL}UCT[ON 3T97SMS CONVENRONAL SUCTION SYSTEMS 101 ISS m PINI') <br /> 1 QS.DAILY VISUALMDTTrOSTE S PUMPING SYSTEM+TRIENNIAL PIPING DL DAILY VISUAL MONNRENG OF PIPING AND PUMPING SYSTEM <br /> wrwA17YTEST(0.1 OPM <br /> C]4.7RIENN AL)NrBGR1TY TEST(0.7 GPFI) <br /> SnlSSLL'TIOta}YS'TFMS Q70 vA1.UE81N ARIAW DROUNDPIPINO): <br /> SAFE SUCTION II(NO YALVC7 IN BELOW GROUND PIlLVO): <br /> ❑7.SELF MONTIOPING ❑7. SELF MONTTORIMC <br /> GRAVRY FLOW I, GRAVITY FLOW tl: 0 Wv): <br /> LlI'QM <br /> 9,EmAL INTEGRITY TEST(61 OPH) <br /> DR. DAILY Vi}UALMONLTORING <br /> ❑9NN. BIPIN-rEOR"TEST(P.I GPM) <br /> yECDNDARILY CONTAINED PIPING <br /> SECONDARILY CONTAINED PWINC <br /> P9,COU LNIJOUFINOTf61apou SUMP ITN AUDIKA AND VISUAL <br /> PRESSURIZED INPMG(Chxuv'dmt 504 CDNTINVAT,0 RBINE SUMP SENEOR9L'T.L° <br /> 10.CONDNVOU9 TUA81N>•ST%INP SENSOR SYICiH AUpIBL$ANA YL4Vnt 10, ALAIV.HS ANDIa�mwf <br /> ALARMS AND(Ca anal j C2, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> AUTOPUMP SHVT OFT'WHEN A LEAK OOCUJU <br /> ❑b AUTO PUMP SHUT OFP fOR LEAKS.SYSTEM FAILURE AND SYSTlA9 <br /> n6 AVIA PLUMP SHUT OFF FOR LEFAILURE AND SYSTEM FAILUAND SYSTEM DISCONNECI1t7N <br /> DI$OONwi>GTION . , pF NO AUTO PUMP SHUT OFF <br /> ❑c NOAUTD PUA>PmUC aFP FLOW SHUT <br /> m <br /> It. AUTOMANCIIM IXAKn618CrOR(SOGPHTeST13Yllt1 Q 14. A[ITOALA7ICLEAKDeTEcraR <br /> '1OFF OR RESTRICTION C) M7 12.ANNUAL INTRORTFST(0-1 OFF) <br /> 4tHdM ANNUAL INFSORI7Y TEST(O•I GPM) SUCNaNJORAV rTY SYSTEM <br /> SUMON10RAWry SYSTEM 1}, CONTINUOUS SUMP SENSOR'S AUDIBLE AND t15UAL gI.PR•MS <br /> []13.COIJrtNI.bUA iUMP EENEaR+nU DIBLIIAHO VIn.N.AI-A`41`HS C313, <br /> P.MLRORNCY GENERATOSR ONLY(Caret W R+-pp6) <br /> phIERGENCY OSNRSAT'O1aS ONLY(dxLep'aal�p7) j QI�CONTIMlOUS SUMP SFNSORE'Lk14�T AUTO PUMP Stitt[OFF' <br /> ❑t4. CONTINUOUS SUMPSlNSOR AUTO PUMP SHUT OFF' AUDIBLE A•^1.D VISUAL ALARMS <br /> AUDBLE AND VISUAL ALARMA <br /> ❑1S. ALR)MATICLINELEAKrMCTORCJ. GPHTESnSYlILT�1T�w IMDII. AUTOMATCIIVALEAK9CfE(TOR(3,PGPM THYn <br /> SPRtr 0"M RL•$TIIICT10N []l6•ANNUAL INTEGRITY TEST(d.1 GPNI <br /> d 16•ANNUAL INTEGRITY TEST(D.i GPM [1 t]. DAILY VISUAL LhIPCK <br /> p17. DAtIYVISUA4 CHECK Vm D16P E. •RCONTAUYMLNT <br /> FS RVALVE ❑4,DAILY VISUAL CHECK <br /> OISPI'ISCR CONTAINMENT I.FLOAT MECtL1.`il$M THAT SMUTS <br /> OF r 5.TItzmcIa LIN-Em i M(YRTORING <br /> DAT"c INSTALLED aan ❑2.CONTINUOUS DISPI LASER PAN SENSOR- VDlar AND V16UAL AI-ARMS ❑ <br /> [3 1-CONTIPR,'OV$DI.SPEN9SIt PAN SENSOR AVTOSMUT OFP POR �6.NONE <br /> pU5 ER•gU171HLE N VISUAL ALA <br /> I%.OWNER)O itA78R SIGNATURE <br /> q9 <br /> ca..ng a.+� hJem.Am a.eneNuert:n W/aaw�ew Oa4�I o(m-'+naMadaa DATEL � '^ <br /> NA OFD OR r l rl <br /> LE O OWN r£RATOR <br /> AmE OR(u nQ <br /> ' 1 '.tlIM DOrC(FCf1K.V ucwly) A•$ <br /> Imrol P'a nanmrl ° <br /> acmm nPo�1°°(Falr ary, ° <br /> 1� Formerly 3WPCD form 8 <br /> UPGF(12/99 revised '� <br />