BILLING - Laserfiche WebLink

Home Browse Search

L "I1NIFIED PROGRAM CONSOLIDATED FORM' UNDERGROUND STORAGE TANKS - TANK PAGE 2 (Clwek A Out. spy) ANIIc FAC IP. IL SYSTEM TYPE ❑ 1. PRESSURE ® 2. SUCTION ❑ 3. GRAVITY .36 ❑ I. PRESSURE ❑ 2. SUCTION [13. GRAVITY - - CONSTRUCTION 01. SINGLE WALL ❑3.LINEDTRENCH ❑SK. OTHER 460 [3 1. SINGLE WALL ❑95. UNKNOWN '..' M2.DOUBLEWALL 095.UNKNOWN ❑2. DOUBLE WALL ❑99.OTHER I f" MANUFACTURER MI MANUFACTURER ❑ 1. BAIZE STEEL ®6. FRP COMPATIBLE./ 199%METHANOL ❑ 1. BARE STEEL ❑ 6, FRP COMPATIBLE W 101MMETHANOL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIUD STEEL 'el ❑ PLASTICCOMPATIBLE W/CONTENTS ❑ 95. UNKNOWN ❑ PLASTIC COMPATIBLE W) CONTENTS ❑ 95. UNKNOWN i ❑ A. FIBERGLASS ❑ B. FLEXIBLE (HOPE) a W. OTHER ❑ a. FIBERGLASS ❑ S. FLEXIBLE (HDPE) ❑ ",OTHER ' ❑ S. STEEL W�COATTNG ❑ 9. CATHODIC PROTECTION �'RTAaYIGu� ty ❑5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION }{: VII. PIPING LEAK DETECTION (Check ell0w 7U6a '0w olds daR belts w'iebal '"�'''> UNDERGROUND PIPING ----- ABOVEGROUND PIP G ' SINGLE WALL PIPING y6 SINGLE ALL C,, PRESSURIZED PIPING (Check all that appy): PRESSURIZED PIPING (Chackall Mat appy): ❑ I. ELECTRONIC LINE LEAK DETECTOR3.0 GPX TEST WITH AUTO PUMP SHUT OFF ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPX TEST Werx AUTO PUMP FOR LEAK, SYSTEM FAILURE, ARID SYSTEM DISCONNECTION -AUDIBLE AND FOR LEAK, SYSTEM FAILURE., AND SYSTEM DISCONNECTION+AUDIBLE VISUAL ALARMS. VISUAL ALARMS. Vit. ❑ 2. MONTHLY 01 GPX TEST ❑ 2. MONTHLY 0.2 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1 GMO ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPM) { ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS (C%eell W that apply) i C) S. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIEAL PIPING 05. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (O.I GPM) ❑ 6. TRLENN IAL INTEGRITY TEST (0,1 GPM) SAFE SUCTION SYSUMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): ❑ 1. SELF MONITORING ,�/ 7. SELF MONITORING cRAvrtv rww Lrj a ❑ 9. BIENNIAL INTEGRITY TEST (0.1) GPM GRAVITY FLOW(Chek all that.pply). ❑ S. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1) GPM SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING RESSTMt7ED PIPING (Check W that apply): PRESSURIZED PIPING (Ckck.11 that apply)! ° - 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TU RBINE SUMP SENSOR WITH AUDIBLE AND VISUAL AIARMSAND(C .) ALARMSAND(CW.) ❑ L AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ e. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b. AUTO PUMP SHUT OFF FOIL LEAKS, SYSTEM FAILURE AND SYSTEM ❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE ANDSYS1* -, 1 DISCONNECTION DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF 5` ❑ 11R1. AUTOMATIC LME LEAK DETELTOR(3.0 GPM TEST) WITH FLOW SHUT OFF OR ❑ II AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH1l SS�U��CC/rIMLIGRAVITY SYSTEM SUCnON/CRAVITY SYSTEM DBt3. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS ❑ U. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS } . EMERGENCY GENERATORS ONLY (CbnA A IIat w1y) EMERGENCY GENERATORS ONLY (aekaa nN appy) ❑ ILC0I9TINUOUB EUMP SENSOR WITH T AUTO PUMP SHUT OFF • ❑14. CONTINUOUS SUMP SENSOR WTTHOUI AUTO PUMP SHUT OFF• a°l AUDIBLE AND VISUAL ALARMS AUDIBLE. AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) W Tl HOUT FLOW ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) WITHOUT FLOW STRUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ I6. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ 17. DAILY VISUALCHECK ❑ 17. DAILY VISUAL CHECK - CONTAINMENT VIIL DISPENSER 0@@(SEACONTAMMENT ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE _-----� ❑ 4_ DAILY VISUAL CHECK ) DATE INSTALLED W ®'2. CONTINUOUS DISPENSE0. PAN SENSOR - AUDIBLE AND VISUAL ALARMS ❑ 3. TRENCH LINER / MONITORM6 �; Q3. CONTINUOUS DISPENSER PAN SENSOR W T11AUTO SHUT OFF FOR ® 6. NONE N DISPENSER AUDIBLE AND VISUAL ALARMS DL OWNER/OPERATOR SIGNATURE l stlytlr pl vdo:selfmpwidnt6aelnk vw utl �al6e halo tuewledae. -.-_-.---...__.__ SIGNATURE OF OWNERiOPERATOR � a,31 / IyIO 3 s. ME OF OWNER/OPERATOR(ptin TITLE OF OWNER/OPERATOR .^I`rAIFX Pan6 NUWe(Fn deNroJy) 173 Pemm Appaed(Fx lxal ute e9y) 171 Per,,.lap'vnbn On• l9a Lae min rvrnnncRAc �_ iEE0000646 1/111993 In