BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

D PROGRAM CONSOLIDATED FO UNDERGRO TA�rKs LjI n I o7 UND STORAGE TANKS - TANK PAGE 2 l VI.PIPING CONSTRUCTION(cnak w teal pry) Pa e 5 of 7 UNDERGROUND PIPING SYSTEM TYPE ®I.PRESSURE CONSTRUCTION/ ❑2.SUCTION L3 3 ORAVITY458' u L ABOVEGROUND PIPING MANUFACTURER I SINGLE WALL ❑3 ❑99 .LINED TRENCH OTPRESSURE 132.SUCTION ❑3.GRAVITY ®2.DOUBLE WA D 95.UNKNOWN . HER 460 ❑I.SINGLE WA L 45g. 95.UM{NpwN MANUFACTURER 112.DOUBLE WALL 462. ❑ I.BARE STEEL (�l I I 461. ❑99 OTHER ❑6.FRP COMPATIBLE W/I00%METHANOL MA�ACTURER ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL �L BARE STEEL 463. ❑2.STAINLESS STEEL 0 6.Flu'COMPATIBLE W/100%METHANOL 3.PLASTIC COMPATIBLE WITH CONTENTS 95.UNKNOWN .FBERGLASS ❑3.PLASTIC COMPATIBLE W/CONTENTS ❑7 GALVANIZED STEEL [15.STEEL W/COATING s�A�) 10199.OTHER 4.pIBERGLASS ❑8.FLEXIBLE(HDPE) ❑99.OTHER ❑9.CATHODIC PROTECTION ❑9.CATHODIC PROTECTION VD.PIPING LEAK DETECTI N 46a. ;STEEL w/coATING O Check all that a I ❑95'UNKNOWN SINGLE WALL,PIPING UNDERGROUND PIPING Adam 'an ofthe monitoring program shall be mbminM to the.locale y) 465 PRESSURIZED PIPING(Check all that a 1 466, SINGLE WALL PIPING ABOVEGROUND PIPING 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESTPUMP PRESSURIZED PIPING(Check all that apply). 467. SHUT-OFF FOR LEAK, SYSTEM FAILURE,AND SYST WITH ON 0 1' ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP +AUDIBLE AND VISUAL ALARMS. SHUT OFF FOR LEAK,SYSTEM FAILURE, ❑2. MONTHLY 0.2 GPH TEST +AUDIBLE AND VISUAL ALARMS AND SYSTEM DISCONNECTION 3. ANNUAL INTEGRITY TEST(0.1 GpH) ❑2' MONTHLY 0.2 GPH TEST ❑3. ANNUAL INTEGRITY TEST(0.1 GPH) CONVENTIONAL SUCTION SYSTEMS ❑4. DAILY VISUAL CHECK ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+T CONVENTIONAL SUCTION SYSTEMS(Check all that a I INTEGRITY TEST(0.1 GPH) RBNNIAL PIPING PP Y) ❑5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEMSAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): [17. SELF MONITORING ❑6' TRIENNIAL ThInORITY TEST(0.1 GPH) GRAVITY FLOW SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) El 7. SELF MONITORING GRAVITY FLOW(Check a0 that apply): ❑8. DAILY VISUAL MONITORING SECONDARILY CONTAINED PIPING 09- BIENNIAL,INTEGRITY TEST(0.1 GPH) PRESSURIZED PIPING(Check all that apply): SECONDARILY CONTAINED PIPING y) PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURK PP Y) ALARMS AND(Check one) ENE SUMP SENSOR WITH AUDIBLE AND VISUAL ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ALARMS AND(Check one) ®It.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS DISCONNECTION ❑b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM On. NO AUTO PUMP SHUT OFF DISCONNECTION ®11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT De. NO AUTO PUMP SHUT OFF OFF OR RESTRICTION 1111. AUTOMATIC LEAK DETECTOR [112. ANNUAL INTEGRTFY 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(Check an that apply) EMERGENCY GENERATORS ONLY(Check all that apply) [114. CONTINUOUS SUMP SENSOR Wfl'HO[IT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF [115. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW AUDIBLE AND VISUAL ALARMS SHUT OFF OR RESTRICTION ❑15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) 0 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) [117. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VUL DISPENSER CONTAINMENT DISPENSER CONTAINMENT 468. ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE STA E32. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 4. DAILY VISUAL CHECK 469. 03. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑5 TRENCH/LINER MONITORING DISPENSER+AT AND VISUAL ALARMS 06. NONE IX.OWNER/OPERATOR SIGNATURE I certify[ha[the information provided her i e d accu e t the best y knowledge. SIGNATURE OF OWNER/OPERATOR DATE: �( C r 470. NAME OF OWNER/OPERATOR(print} v 'J,-0j, OJ' h'1 C f TITLE OF OWNER/OPERATOR: 4'12. Pemut Number(Agency use only) 473. Permit A roved B ,-guse only) -PP Y(Agency Y) 474. Pemut Expitxdon Date(Agency use only) 471 UPCF hwfwrc-b(1/99)-3/4 httP://www.unidocs.org Rev.02/16/00