BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

IFIED PROGRAM CONSOLIDATED F TANK UNDERGROUND STORAGE TANKS TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all that apply) Page 4 of 6 UNDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE 0 1.PRESSURE 0 2.SUCTION D 3.GRAVITY 459 1 0 1.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 CONSTRUCTION 0 L SINGLE WALL [13.LINED TRENCH D 99.OTHER 460 ❑1.SINGLE WALL D 95.UNKNOWN 462 MANUFACTURER 0 2.DOUBLE WALL D 95.UNKNOWN ❑2.DOUBLE WALL 0 99.OTHER MANUFACTURER AO Smith 461 MANUFACTURER 463 ❑1.BARE STEEL D 6.FRP COMPATIBLE w/l0w4 METHANOL 0 1.BARE STEEL 0 6.FRP COMPATIBLE w/100%METHANOL D 2.STAINLESS STEEL [17.GALVANIZED STEEL D Unknown ❑2. STAINLESS STEEL D 7.GALVANIZED STEEL [13.PLASTIC COMPATIBLE W/CONTENTS [199. Other ❑3. PLASTIC COMPATIBLE W/CONTENTS [18.FLEXIBLE(HDPE) [199. OTHER ®4.FIBERGLASS D S.FLEXIBLE(HDPE) ❑4. FIBERGLASS 0 9.CATHODIC PROTECTION [15.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING 0 95.UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that a ly)(A description ofthe monitoring"man shall be submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT 0 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 0 2. MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(O.IGPH) 0 3.ANNUAL INTEGRITY TEST(0.IGPH) 0 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) 0 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUND PIPING): [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 D 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): D S. DAILY VISUAL MONITORING 0 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(Check one) ALARMS AND(Check.) No AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 19 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM D b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION De. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF 0 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION D 11. AUTOMATIC LEAK DETECTOR 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. 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 thin apply) [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION 0 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) [116.ANNUAL INTEGRITY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) D 17. DAILY VISUAL CHECK 0 17. DAILY VISUAL CHECK VII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT D 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE D 4.DAILY VISUAL CHECK DATE INSTALLED "a 0 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS D 5.TRENCH LINER/MONITORING 9/28/90 10 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS LY.OWNER/OPERATOR SIGNATURE Icenifythmtheinfornetio wovidedheminis a 'd accurate to the best ofmy knowledge. SIGNATURE OF DATE 470 RX LE9U 5/30/02 NAME OF OWNS OP nt) TITLE OF OWNER/OPERATOR 472 Chevron Products Com a /D.R.LERI Retail ESH Specialist Permit Number(Fm local use only) 473 Permit Approved(For local use only) Permit Expiration Date(For local use only) 475 UPCF(1/99 revised) 176 Formerly SWRCB Form B