BILLING - Laserfiche WebLink

Home Browse Search

VIED PROGRAM CONSOLIDATED FOJP ! TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 V1.PIPING CONSTRUCTION(G�eck an that ap I) Pae of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE D 1.PRESSURE [12.SUCTION ❑3.GRAVITY 45a. 111 PRESSURE C 2.SUCTION C 3.GRAVITY 459, CONSTRUCTION/ D 1.SINGLE WALL C 3.LINED TRENCH C 99.OTHER 460. C 1.SINGLE WALL C 95.UNKNOWN 462. MANUFACTURER [12.DOUBLE WALL ®95.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461. MANUFACTURER 463, ELBARE TEEL C 6.FRP COMPATIBLE W/100%METHANOL C 1.BARE STEEL D 6.FRP COMPATIBLE W/100%METHANOL ESS STEEL D 7.GALVANIZED STEEL C 2.STAINLESS STEEL ❑7.GALVANIZED STEEL C COMPATIBLE WITH CONTENTS ®95.UNKNOWN D 3.PLASTIC COMPATIBLE W/CONTENTS C S.FLEXIBLE(HDPE) D 99.OTHER LASS D 8.FLEXIBLE(HDPE) C99.OTHER D 4.FIBERGLASS D 9.CATHODIC PROTECTION W/COATING D 9.CATHODIC PROTECTION 464. D 5.STEEL W/COATNG D 95.UNKNOWN 465. VIL PIPING LEAK DETECTION(Check.11 theta I)(A desI60n Of =MOTing p1c,lun1W l bewabmited to the]melacnc ) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): C 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP C 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. [12. MONTHLY 0.2 GPH TEST [12. MONTHLY 0.2 GPH TEST [13. ANNUAL INTEGRITY TEST(0.1 GPH) [13. ANNUAL INTEGRITY TEST(0.1 GPH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) C 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW C7. SELF MONITORING [19. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): [18. DAILY VISUAL MONITORING 119 BIENNIAL INTEGRITY TEST(0.1 GPID SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR MM AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check one) ALARMS AND(Check one) ❑3. AUTO PUMP SHAT OFF WHEN A LEAK OCCURS D a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM C b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Cc. NO AUTO PUMP SHUT OFF Cc. NO AUTO PUMP SHUT OFF 011. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION CIl AUTOMATIC LEAK DETECTOR C 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) D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF [114. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS [115, AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION C 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) 016. ANNUAL INTEGRITY TEST(0.1 GPH) D 16. ANNUAL INTEGRITY TEST(0.1 GPH) D IT DAILY VISUAL CHECK C 17. DAILY VISUAL CHECK VIII:DISPENSER CONTAINMENT. DISPENSER CONTAINIelEN'7 468. C1. FLOAT MECIIANISM THAT SHUTS OFF SHEAR VALVE D4. DAILY VISUAL CHECK 469. DATE INSTALLED [12. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS C 5. TRENCH/LINER MONITORING ❑3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ®6. NONE DISPENSER AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I certify that the informati ro ` e erein is nd a ate to the best of my knowledge. SIGNATURE OF OWNE E DATE:04-23_2004 azo. NAME OF OWNER/OP TOR(print): CHRISTOPHER MILLER TITLE OF OWNEWOPERATOR: AGENT FOR OWNER(AGE) 472. Permit Number(Agency use only) 473 1 Permit Approved By(Agency use only) 474. 1 Pemut Expiration Date(Agency use only) 475. UPCF hwfwrc-b(1/99)-3/4 http://www.unidocs.org Rev.02/16/00