BILLING 2002 - 2012 - Laserfiche WebLink

Home Browse Search

low UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION(Ohackak'MAtapply) 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 ❑99. OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER , DOUBLE WALL 1195. UNKNOWN ❑ 2. DOUBLE WALL 110 OTHER MANUFACTURER MANUFACTURER ❑ 1.BARE STEEL ❑ G. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE W/100%METHANOL MATERIALSAND ❑ 2, STAINLESS STEEL ❑ T. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTICCOMPATIBLEWATHCONTENTS 1195. UNKNOWN ❑ 1 PLASTIC COMPATIBLE WITH CONTENTS ❑ B. FLEXIBLE(HDPE) ❑99. OTHER FIBERGLASS ❑ B. FLEXIBLE(HDPE) CIO OTHER ❑ 4. FIBERGLASS ❑ S CATHODIC PROTECTION ❑ S. STEEL WI COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WI COATING ❑95. UNKNOWN VIL PIPING LEAK DETECTION(Chad an that appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALLPIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chack as Mat appy: PRESSURIZED PIPING(Chack aB that apply): - ❑ 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST LITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE 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♦AUOIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM TEST 112. MONTHLY 02 GPM TEST 11 3.ANNUAL INTEGRITY TEST(0.1 GPM) 113. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check 0 Mat appy): ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ e.TRIENNIAL INTEGRITY TEST IDA 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(Chsck ek Mat appy): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TOT(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that appy): PRESSURIZED PIPING(Check as that appy): 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND ,(C &one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Aleck ane) ,F.S4. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ e.AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ In AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ a.NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11.AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION/GRAVITY SYSTEM: SUCTIOWGRAVIW SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR(AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check air Mat appy) EMERGENCY GENERATORS ONLY(Chack 80 that appy ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF r AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF a AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(10 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC LINE LEAK DETECTOR(10 GPM TEST) RESTRICTION ❑ 18.ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 18.ANNUAL INTEGRITY TEST IDA GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 1. FLOATMECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INST LLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR-AUDIBLE AND VISUAL ALARMS ❑ S. TRENCMUNER/MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSORWITH AUTO SHUT OFF FOR DISPENSER-AUDIBLE AND VISUAL ALARMS ❑ e. NONE IX.OWNER/OPEIIATOR SIGNATURE 1 certy Mat Me Information Provided herein is true and apvrote W Me beat of my ktwMe 1p, SIGNATURE OF OMER/OPERATOR DATE NAME OF OWNER/OPERATOR(pent) TIRE OF OWNERiOPERATOR Permit Number(Forbrwl uses only) Permit Approved(FarMcal use Mayl PomIK Expraeon DMe(Forbcal use oafy) CUPAFORM(4/99) • Formerly SWRCR Form B