BILLING_2002-2011 - Laserfiche WebLink

Home Browse Search

�FIED PROGRAM CONSOLIDATED FORM• TANK: TA0515637 PR #: PRO231595 FAC #: FA0003591 UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION (Chink nil ihat.Ppy) Page 3 of 7 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ® L PRESSURE ❑ 2. SUCTION ❑ I GRAVITY 456 ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 459 CONSTRUCHON ❑ 1. SINGLE WALL ❑3. LINED TRENCH ❑ 99. OTHER 460 ❑ I. SINGLE WALL ❑ 95. UNKNOWN 463 1@2 DOUBLE WALL [M95, UNKNOWN ❑ 2. DOUBLE WALL E]99.OTHER 463 461 MANUFACTURER A O SMITH MANUFACTURER ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE w/ 100.6 METHANOL ❑ L BARE STEEL ❑ 6. FRP COMPATIBLE w/ il. METHANOL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ PLASTIC COMPATIBLE W/ CONTENTS ❑ 95. UNKNOWN ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95. UNKNOWN ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE (HDPE) ❑ 99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE (HDPE) ❑ 99. OTHER ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464 ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 465 VO. PIPING LEAK DETECTION (Check dl Nat ropN) U dnctiPum otthe woniwine pwgrem shell be mbaiucd w me lural agmD.) ABOVEGROUND PIPING SINGLE WALL PIPING 467 UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF PRESSURIZED PIPING (Check all that apply): ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) CONVENTIONAL SUCTION SYSTEMS ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM F15. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIEAL PIPING INTEGRITY TEST (0.1 GPH) ❑ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW (Check all that apply): ❑ 9. BIENNIAL INTEGRITY TEST (0.1) GPH ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1) GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Chwkam) ALARMS AND (Checkom) C:1 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS F -1a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS E] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ® I L AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR ❑ 11 AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Chink all inn appy) EMERGENCY GENERATORS ONLY (Cheek ali that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF • ❑ 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF 4 AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW ❑ 15. RIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW ❑ SHUT OFF OR RESTRICTION SHUT O OR TION ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 77. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VID. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATEINSTALLED 468 ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+ AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING ® 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑ 6. NONE 469 DISPENSER + AUDIBLE AND VISUAL ALARMS UL OWNER/OPERATOR SIGNATURE 1 m.tiy Nn die info�maom P.oa'iEW hcmin is uve oM amurnc w Ua benof myknmvlWec. SIGNATURE OF OWNER/OPERATOR DATE 470 NAME OF OWNEF/OPERATOR (print) TITLE OF OWNER/OPERATOR 472 471 AMARRT SINGH OWNER Permit NomM(For kcal.. mh) 473 Pamir APpw1 d(F. Iwai me omy) 474 P=it Expiation Datc(Fm lmal ac ordO 475 EE0000817 12/31/1999 12:00:OOAM PT0003666 UPCF (12/99 revised)