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-Nov-13-2002 11:2Tam Frcm-ARCO PRODUCTS +714-670-3095 T-817 P 005/007 F-536
<br /> raIIIIIV1) PR(1(.RAM Cf1\r',CC1T.TnATF.1) VO ----
<br /> TANKS
<br /> UNDERGROUND STORAGE TANKS- TANK PAGE 2
<br /> VI.PIPIN 'CONSTRUCTIONICT>ca14n rhat.pplyl Pae of
<br /> LINDERGROLND PIPING ABOVEGROLND Pp1p1NG
<br /> SYSTEM 1TYrk ®1.PRESS1,II2F, ©2 SUCTION ❑3.GRAVI'T'Y =38 Q 1.PRESSURE ❑ SUCTION Q GRAVITY 4sa
<br /> CONSTR N/ ©1.SLN'GLE WALL 0 3,LINED TRENCH ❑99.OTH1iR ase Q 1.SINGLE WALL
<br /> MANUF4,C URER Q 95.UNKNOWN 462.
<br /> ®2.DOUBLE WALL 1195,UNKNOWN Q 2.DOUBLE WALL
<br /> ❑99,OTHER
<br /> MANUFACTURER �! MANUFACT CJW-a 469.
<br /> ❑1.BARE STEEL ❑6.FRP COMPATIBLE w/1DO`%METHANOL ❑ 1.BARE,STEEL ❑6,FRP C0.'1y>ATIBLE W.'IOD%WTHANOL
<br /> ❑2,STAINLESS STEEL Q 7.GALVAN1220 STEEL ❑2 STAINLESS STED ❑7.GALVANIZED STEEL
<br /> Iv 3.PLASTIC COMPATIBLE WITH CONTENTS [3 95.UNKNOWN Q 3.PLASTIC COLOA'I IBLE W1 CONTENTS ❑8,FLEXIBLE(HDPE) ❑99.OTHER
<br /> 4.FIBERGLASS ❑6.FLEXIBL]?RIDPE) D 99,OTHEF ❑4.FIBERGLASS
<br /> ❑9.CATHODIC PROTEC'T'ION
<br /> ❑5 STEEL 1V/COATING ❑9.CATHODIC PROTECT/ON 464 i'Q 5 STEEL W/COATTD••i ❑95.UNKNOWN 465 ,
<br /> VII.PIP NIC:LEAKDEI'IFCj'lON Cho&all iha IAdevarinion offs ma,iwrv, rn m:halt boaseoronOu to tFa,bcel. y
<br /> UNDERGROUND P1P1`dG ABOVEGROUIVDPIPL14G
<br /> SINGLE WALL PIPING 46e SINGLE WALL PIPING 46;
<br /> PR£Sb�URILED PIPJNG(Check ill that app',y): I PRESSURIZI n PIPING(Check at:that apply):
<br /> fl C3
<br /> I. ELECTRONIC LINLEAK AK DETECTOR 3.0 OPH TEST WITH AUTO PUMP ❑t. ELECT,cON1C LINE LEAK DFTECTOR 3 0 GPH TEST WIT14 AUTO PUMP I
<br /> SHUT-OFF FOR LEAK,SYSTEM FATLVU1 .AND SYSTEM DISCONNECMN SFIU'T I AFF FOR LEAK,SYSTEM FA'LURE,AND SYSTEM DISCONNECTION III
<br /> AUDIBLE AND VISUAL ALARMS -AUDIBLE AND'Vt$UAL ALARMS,
<br /> [12. MON'T'HLY 0.2 GPH TEST 02 MONTI ILY 0.2 GPH TEST
<br /> ❑3. ANNUAL INTEGRITY TEST(0,1 GPII) 0 3, ANNUdl INfBGRITY'TEST(0 t GPH)
<br /> 04. DAILY VISUALCHLCK
<br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIOYAL!SUCTION SYSTEMS(Chcok 4it that apply)
<br /> ❑5. DAII.Y VISUAL MONTTORING OF'PUMPING SYSTEM•,TRI%NNIAL PIPING
<br /> INTEGRITY TEST(0,1 GPM) ❑S DAILY VISUAL MONITORING OF PIPINt3 AND Pall 1NG SYSTEM
<br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)! ❑6- TRIENI,IAL INTrGRITY TEST(O.l GPH) f!
<br /> ❑7. SELF MONITORING SAFE SUCTI(In SYSTEMS(NO VALVES IN BELOW GROUND PIPING):
<br /> GRAVITY FLOW I ❑7. SELF MONITORING
<br /> 119, BIENNIAL INTEGRITY TES-l-,0,1 GPH) GRAVITY FL+IW tChack all that apply):
<br /> I ❑Il. DAILY tfSUAL MGNI7.ORING
<br /> ❑9. BIENNI,,L LVTEGRl7y TEST(o.l GPH)
<br /> ! SECONDARIILY CONTAINED PIPING SECONDARILY CONTAINED PIPING
<br /> PRESSURIZED PIPINC(Check all Otar appl ): PRESSURIZEI r PIPING(Check all that apply):
<br /> 10, CONTINUOUS TURBINE SUMP SENSOR Wrrt4 AUDIBLE AND VISUALi 10, CONTINUOUS TUR2TNl SUMP SENSOR WITH AL7S!13LE AND vISL'AL
<br /> ALARMS AND(Check one) I ALARA:3 ANIS(Check one)
<br /> [3a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Ma.Al'TO PUMP SHUT OFF WHEN A LEAK OCCURS
<br /> ®b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b.Ai ITO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM
<br /> DISCONNECTION Di WONNECTION
<br /> i]e. NO AUTO PLW SHUT OFF Inc NI-AUTO A;MP SHUT OFF
<br /> IM 11, AUTOMATIC LINE LCAT,DETECTOR(3.0 OPII TEST)W(TH FLOW SHUT
<br /> OFF OR RESTRICTION ❑11. AUTON 1TIC LEAK DETECTOR
<br /> ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) C]17 ANNUA,.INTEGRITY TEST(0.1 GPH)
<br /> SU'CTIONIGRAVITY SYSTEM SUCTLONIGRA CITY SYSTEM
<br /> ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13,CONTBNJOUS SI-IMP SENSOR,AUDIBLE AND VISUAL ALAR-mS
<br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENKRATORS ONLY(Check ell:(tat apply)
<br /> ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SI•IUT OFF ❑ 14.CONTI NOUS SUMP SENSOR-V TI{C.UT AUTO PLINe SHUT OFF
<br /> AUDIBLE AND VISUAL ALARMS AUDIB:.E AND VISUAL ALARMS
<br /> ❑15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) wmwntiT FLOW
<br /> SHUT OFF OR RESTRICTION ❑I5 AUTOl.tATtTF
<br /> 1CI.INELEAKnCTGR(3.OGPFITEST)
<br /> 016. ANNUAL INTEGRITY TEST(0.1 GPH) 0 16.ANNUL INTE6RITYTEST(0,!OPFl)
<br /> ❑11. DAILY VISUAL CHECK M 17, DAILY VISUAL CHECK
<br /> VIJI.J]ISP.ENSER CONTAININILNT
<br /> DISPENSER CONTAINMENT aha. 1 ❑I. FLOAT MECHANISM THAT SHUTS OFF S14EAR VALA,i ❑4, DAILY VISUAL CIMCK 469
<br /> DATE INSTALLED IM2. CONTINUO*!SDISPL•NSERPAN$_NSOR-ALJDEBLE,\NDVIS(IALALAnIS ❑s. TRENCH/LINERiv10NITORINO
<br /> 1071999 ❑1 CONTINUOUS DISPENSER PAN SENSOR W1TTi ,x,)'1'0 SHUT OFF FOR ❑6 NONE
<br /> __111 DISPENSER T AUDIAL2 AND VISUAL,ALARIvfS
<br /> AC.OWNEWOPERATOR SI(;NATI IRE
<br /> I certif that the information provided bewin is true and accurate to the best of my knowledge. ��-
<br /> SIGN v 0 R A I 0XII DATE:
<br /> NA]2 O 4PERATOR(print): JOHN SCHETrER TITLE OF OWN`!R/OPERATOR: EnVifOnmental Compliance 01
<br /> Permit Number(Agency ttaa Only) Ova 1 Permit Approved My(Agency asa only) 474. Pau,t Expiration Date(.4E•en;:y use only) a7I.
<br /> UPCF hwllvre-b(1/9'1)-3/4 tlt4p:/hvww.unidamorg Rev,0:116/00
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