BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

w MIDUD PROGRAM CONSOLIDATED FO '1 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 Pae 7 of 7 VI.PIPING CONSTRUCTION(check dl that ap 1y) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE D 2.SUCTION [13.GRAVITY 4% [11.PRESSURE D 2.SUCTION D 3,GRAVITY 459, CONSTRUCTION/ D I.SINGLE WALL D 3.LINED TRENCH [199.OTHER 460. D 1.SINGLE WALL ❑95.UNKNOWN 462 MANUFACTURER ®2 DOUBLE WALL D 95.UNKNOWN [12.DOUBLE WALL ❑99.OTHER 463, 1. MANUFACTURER MANUFACTURER 1 D 1.BARE STEEL [16.FRP COMPATIBLE W/100%METHANOL D 1. ARE STEEL [:16 FRP COMPATIBLE W/100%METHANOL D 2.STAINLESS STEEL [17.GALVANIZED STEEL [12.STAINLESS STEEL [17.GALVANIZED STEEL [13.PLASTIC COMPATIBLE WITH CONTENTS [195.UNKNOWN [13.PLASTIC COMPATIBLE W/CONTENTS D 1.FLEXIBLE(HDPE) [199.OTHER ®4.FIBERGLASS D S.FLEXIBLE(HOPE) D 99.OTHER [14.FIBERGLASS [19.CATHODIC PROTECTION q65. [15.STEEL W/COATING ❑9.CATHODIC PROTECTION 464. [15.STEEL W/COATING [195.UNKNOWN VIL PIPING LEAK DETECTION(Check all that ty) Adescri 'on ofthe monitoring Was=Shell be nbmitted to the local egancy. UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466. SINGLE WALL PIPING 467' PPRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): ❑ L ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT-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 [12. MONTHLY 0.2 GPH TEST [13. ANNUAL INTEGRITY TEST(0.1 GPH) 03. ANNUAL INTEGRITY TEST(0.1 GPH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) D 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING [35. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 06. TRIENNIAL-INTEGRITY TEST(0.1 GPH) [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW D7. SELF MONITORING 09. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): [19. DAILY VISUAL MONITORING [19. 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 one) ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS D a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ®IS. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM D h. AUTO PUMP SHUT DISCONNECTION OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION Dc. NO AUTO PUMP SHUT OFF On. NO AUTO PUMP SHUT OFF ®11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT D 11 AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) [112. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS [113. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF [114. CAONT N OUSS SUDIBLE AND UMP SENSOR SUAL AWITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS LARMS D 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION [116. ANNUAL INTEGRITY TEST(0.1 GPH) ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) [117. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 461. ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE D 4. DAILY VISUAL CHECK 469. DATE INSTALLED ❑2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [15. TRENCH/LINER MONITORING T 6 Y D� 0 3 DIS It AUISE DIBLESER AND VISUAL ALARMS SENSOR WITH AUTO SHUT OFF FOR [16. NONE IC.OWNER/OPERATOR SIGNATURE I certify that the information provided her 'n' and ac urate to the best of my knowledge. 470. SIGNATURE OF OWNER/OPEEA I UK DATE: 472. NAME OF OWNER/OPERATOR(print): ( f TITLE OF OWNER/OPERATOR: M614- 570M Permit Number(Agency use only) / r 473 1 Permit Approved By(Agency use only) 474 1 PcnTrl Expiry ion Date(Agency me only) 475. UPCF hwfwre-b(1/99)-3/4 http://www.unidocs.org Rev.02/16/00