BILLING 2002 - 2012 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION.(Check a)Net appy) _ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSTRUCTIOW ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑89. OTHER ❑ L SINGLE WALL ❑95. UNKNOWN - MANUFACTURER DOUBLE WALL 1195. UNKNOWN ❑ 2. DOUBLE WALL 1199, OTHER MANUFACTURER MANUFACTURER - ❑ 1.BARESTEEL ❑ 8. FRPOOMPATIBLEW/100%METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2, STAINLESS STEEL ❑ T.GALVANIZEDSTEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ S. FLEXIBLE(HDPE) - ❑99. OTHER 4. FIBERGLASS ❑ B. FLEXIBLE(HDPE) 110 OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑ S. CATHODIC PROTECTION I❑ 5. STEELWICOATING 1195. UNKNOWN VII.PIPING LEAK DETECTION(Chedallthstspply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALLPIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chack Other appy): PRESSURIZED PIPING(Chad air that appy): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION-AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION~AUDIBLE AND VISUAL ALARMS ALARMS 112. MONTHLY 0.2 GPH TEST 11 2. MONTHLY D2 GPM TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check eA that apply): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ T. SELF MONITORING ❑ T. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check a9 that apply: ❑ S. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ S. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that appy): PRESSURIZED PIPING(Chad 0 that apply): 10. CONTINUOUS TURBINE SUMP SENSOR HATHAUDIBLE AND VISUAL ALARMS AND ( 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(creak one) , -V ChgFk Aana)UTO PUMP SHUT OFF WHENALEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN LEAK OCCURS ❑ E. AUTO PUMP SHUT OFF FOR LEAK$,SYSTEM FAILURE AND SYSTEM ❑ E. AUTO PUMP SHUT OFF FOR LEAK$,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF ❑ c NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SMUT OFF OR ❑ 11, AUTOMATICLEAKDETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION/GRAVITY SYSTEM: SUCTIOWGRAVITYSYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check sit Met apply EMERGENCY GENERATORS ONLY(Check as that apply] ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION - ❑ 16. ANNUAL INTEGRITY TEST 10.1 GPM) ❑ 16. ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VHL DISPENSER CONTAINMENT DISPENSER CONTAINMENT1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 114. DAILY VISUAL CHECK DATEIN ALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE AND VISUAL ALARMS ❑ 6. NONE DL OWNER(OPERATOR SIGNATURE I unity Net Ne InMmaibn pnN4a4 herein is Cue ark aooann M Ne East of my knWaE9e. SIGNATURE OF OWNER/OPERATOR DATE - NAME OF OWNER/OPERATOR(pan0 TITLE OF OWNERIOPERATOR PNmit Number(Forlacal use any) Pamtit Approaee(Forlossl use only) PennK EVIintion Data(Forlocal use only) CUPAFORM(4/99) • • Formerly SWRCB Form B