COMPLIANCE INFO_2003-2008 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM • TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 UNDERGROUND PIPING VI.PIPING CONSTRUCTION(Check ad that apply) SYSTEM TYPE ABOVEGROUND PIPING aPRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ t. PRESSURE 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ 1- SINGLE WALL ❑ 3. LINED TRENCH ❑99 OTHER ❑ 1. SINGLE WALL MANUFACTURER 2. DOUBLE WALL C195. UNKNOWN MANUFACTURER ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER ❑ 1,BARE STEEL ❑ 8. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 8. FRP COMPATIBLE W!70095 METHANOL CORROSION ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEX18LE(HDPE) ❑99. OTHER. ❑ 4. FIBERGLASS ❑ S. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 11 ®. CATHODIC PROTECTION ❑ S. STEEL W/COATING ❑95. UNKNOWN ' VII.PIPING LEAK DETECTION(Check an that appy) UNDERGROUND PIPING SINGLE WALL PIPING ABOVEGROUND PIPING PRESSURIZED PIPING(Check aN that apoly): SINGLE WALL PIPING PRESSURIZED PIPING(Check as that apply): ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SMUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION.AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS L ALARMS ❑ 2. MONTHLY 0 2 GPM TEST ❑ 2_ MONTHLY 0.2 GPM TEST ❑ 3 ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check all that apply): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0 1 GPM) ❑ 8. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)' ❑ 7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑ 7. SELF MONITORING -. ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) - GRAVITY FLOW(Cheek all that apply): ❑ 8. DAILY VISUAL MONITORING 119 BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING PRESSUP,IZED PIPING(Check all that apply): SECONDARILY CONTAINED PIPING 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND PRESSURIZED PIPING(Cheek all that appy): (Crack one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS C1 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ D AUTO PUMP SMUT OFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SHUTOFF ❑ c. NO AUTO PUMP SMUT OFF ❑ 11 AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ it. AUTOMATIC LEAK DETECTOR ❑ 12 ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GRH) 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 as that appy) EMERGENCY GENERATORS ONLY(Check ap that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF-AUDIBLE AND VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF r AUDIBLE AND VISUAL ALARMS t5. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SMUT OFF OR RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 18.ANNUAL INTEGRITY TEST(O.t GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INSTALLED 112. CONTINUOUS DISPENSER PAN SENSOR*AUDIBLE AND VISUAL ALARMS 05. 4. DAILY VISUAL CHECK 133. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER a AUDIBLE AND VISUAL ALARMS 1:18. NONE TRENCH LINER/MONITORING t certify that the)nfonnaban Provided heroin is bus and accurate to the best of my knove ge.X•OWNER/OPERATOR SIGNATURE SIGNATURE OF OWNER/OPERATOR DATE NAME OF OWNER'OPERATOR(pool) TITLE OFOWNER/OPERATOR Permit Number(Fwlocal use only) Permit Approved(Forlocal uss ony) Permit ERpiration Date(Forfocat use only) CUPAFORM(4199) Formerly SWRCS Form 6