COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANKS Page Of NI PIPING CONSTRUCTiON-am,t'ePP+rt SECONDARILY CONTAINED PIPING UNDERGROUND PIPING { ABOVEGROUND PIPING SYSTEM ME ❑ t. PRESSURE 112 SUCTION Cl 3. GRAVITY 456 ❑ 1. PRESSURE ❑ ❑ i 2 SUCTION 3, GRAVITY 459 CONSTRIK:TTOWI❑ 1. SINGLE WALL ❑ S LLNEO TRENCH ❑ 99, OTHER 460 I ❑ 1. SINGLE WALL ❑ 95. UNKNOWN 462 11 NUFACTURERI ❑ 2 DOUBLE WALL ❑ 95. UNKNOWN ❑ 2 DOUBLE WALL ❑ 99. OTHER I ❑ D. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE MANUFACTURER 461 MAI.'UFACTURER 463 AND SYSTEM DISCONNECTION ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE Yd IW% METHMOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE wI00% METHANOL MATERWLS AND Cl2 STAINLESS STEEL 117. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ T. GALVANIZED STEEL CORROSION PROTECTION Cl 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WTTI( CONTENTS ❑ 6. FLEXIBLE (HOPE) ❑ 99. OTHER _ ❑ 4. FIBERGLASS ❑ 6 FLEXIBLE (HDPE) ❑ 99. OTHER ❑ 4, FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ S. STEEL W7 COATING ❑ 9. CATHODIC PROTECTION 464 ❑ 5. STEEL WI COATING ❑ 95. UNKNOWN 465 - :VII. PIPING-tEAICUETECTION (--hr AS OW AA, iy) (A desa(pSon cl trte flwA>iv Pmvram Shil be svbmiftsd to co local4gcncy UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 4671 PRESSVRFZED PIP WG (Check ad Nat apply): PRESSURIZED PIPING (Check of that apply). ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST WrTH AUTO PUMP SHUT OFF FOR ' ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SNIT OFF FOR LEAK �m rv�v c., .v J Cm vUk,vnrvtt, I Ivn • AUU.Lt A 0 VISUAL ALARMS ❑ 2 MONTHLY 0 2 GPH TEST '-J 3. ANNUAL INTEGRITY TEST (0.1 GPH) :;O NVENTIONAL SUCTION SYSTEMS. 5 GAILY VISUAL MONITORING OF PUMPING SYSTEM • TRIENNNW PIPING IKTEGRrTY TEST (0.1 GPH) c SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING) 7. SELF MONITORING ARTY FLOV4 9 BIENNIAL INTEGRITY TEST (0.1 GPH) SYSTEM FAILURE, AND SYSTEM DISCONNECTION • AUDIBLE AND VISUAL ALARMS ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3 ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Chock as awl apply): Cl 5. DAILY VISUAL MONrTORING OF PIPING AND PUMPING SYSTEM ❑ 6 TRIENKLAL INTEGRITY TEST (0.1 GPH) SA=E SUCTION SYS TEALS (NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING GRAVITY FLG:'l (Che^sk al that appy): ❑ 9 GAILY VISUAL MONITORING ! ❑ 9 6IENY:IL. LNTcGRrTY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING 'cSSURIZED PIPING (Check as Lha: appy): SECONDARILY CONTAINED PIPING PAESSURIZ O PIPING (Check a6 Mat 10 CONTINUOUS TURBINE SUMP SENSOR WTTN AUDIBLE AND VISUAL ALARMS AND i (Check one) 10. CON, WWUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARM S AND (&,<* one) ❑ A. AUTO PUMP SHUT OFF NMEN A LEAK OCCURS ❑ a AUTO PUMP SHUT OFF V&iEN A LEAK OCCURS ❑ C. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM I ❑ D. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE DISCONNECTION AND SYSTEM DISCONNECTION ❑ c NO AUTO PUMP SHUT OFF I ❑ c NO AUTO PUMP SHUT OFF 7 11 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR ❑ 11. AUTOV.LTIC LEAK DETECTOR RESTRICTION . ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM. ' S'JCTIOWGRAVITY SYSTEM: ❑ 13 CONTINUOUS SUMP SENSOR • AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR • AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Chcck as 0aat appy) EMERGENCY GENERATORS ONLY rAent &I that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHAUTO PUMP SHUT OFF • AUDIBLE AND : ❑ 14. COt--rLX000S SUMP SENSOR VATHO(IT AUTO PUMP SHUT OFF • AUDIBLE AND VISUAL VISUAL ALARMS j ALAtVS <] is. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) IVffTi FLOW SHUT OFF OR ❑ 15. AUTO.MATTC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION ❑ 16. ANNUAL INTEGRr)Y TEST (0.1 GPH) ( ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPM' Cl 11. DAILY VISUAL CHECK 1 ❑ t7. DAILY VISUAL CHECK ... >.....:. .: .. IRR.cilsPer(sERcoNTa(NT,TEiNT:::: DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUALGFtECK DATE INSTALLED 468 Cl2 CONTINUOUS DISPENSER PAN SENSOR • AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER / MON(TORING Cl 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER • AUDIBLE AND VISUAL ALARMS ❑ 6. NONE 469 . %'"IX :OWNERIOPERATORSIGNATURE __ 3:.... - ' ... _ ♦ I Unit k/ ® Iry NAME OF OWNEMPERATOR (PAnU�� 471 OF * ER/OPE TOR 472 t rru lido cc4►� / \lam. i avvrN P-4 MoZer (Foe local use on yj !T3 i Penn4 Approved (For IoW use orM 474-1 Pormd E.V"tion Date (Far tical ase oMy) <75 i '.JPCF (1799 revised) 7 Formerty SWRCB Form B