COMPLIANCE INFO_2003-2008 - Laserfiche WebLink

Home Browse Search

IF NIFIED PROGRAM CONSOLIDATED FORM • TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 2 UNDERGROUND PIPING Vi.PIPING CONSTRUCTION(Check alt thatapp6j Of - SYSTEM TYPE ,,ma�yy ABOVEGROUND PIPING LJ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑ Y. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑99 OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER 2. DOUBLE WALL ❑95. UNKNOWN ❑ 2. DOUBLE WALL ❑99. OTHER MANUFACTURER MANUFACTURER ❑ I.BARE STEEL ❑ 8. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ S. FRP COMPATIBLE W/100%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. FLEXIBLE(HOPE) ❑99. OTHER. ❑ 4. FIBERGLASS ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 13 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑95. UNKNOWN ' VII.PIPING LEAK DETECTION(Check ad Chet appy) UNDERGROUND PIPING SINGLE WALL PIPING ABOVEGROUND PIPING PRESSUR12ED PIPING(Check all that apply); PRESSURIZED PIPING(Check all that appy):SINGLE WALL PIPING ❑ 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 SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTION AUDIBLE AND VISUAL ALARM 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 appy): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0 t GRH) ❑ 8. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING)- 0 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(Check as that appy); - ❑ B. DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): SECONDARILY CONTAINED PIPING 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND PRESSURIZED PIPING(Check all that apply): (Check ono) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) ❑ a AUTO PUMP SMUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS C1 AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SMUT OFF ❑ C. NO AUTO PUMP SHUT OFF ❑ 11 AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11. AUTOMATIC LEAK DETECTOR ❑ 12 ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIOWGRAVITY SYSTEM SUCTION/GRAVITY SYSTEM: ❑ 13 CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that appy) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SMUT OFF♦ EMERGENCY GENERATORS ONLY(Check all that appy) VISUAL ALARMS AUDIBLE AND ❑ 14.CONTINUOUS SUMP SENSOR WTHOUTAUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR AU RESTRICTION ❑ t5.AUTOMATIC OMATIC LINE LEAK DETECTOR(3.0 GPM TEST) ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPM) - ❑ 18.ANNUAL INTEGRITY TEST(0.t GRH) ❑ 17. DAILY VISUAL CHECK . ❑ 17. DAILY VISUAL CHECK Vlll.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INSTALLED C32. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS S.4. DAILY VISUAL CHECK ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS 116.NONECM LINER/MONITORING I certify that the in1orm3e0n Provided herein is bue and accurate to the best of my knovAed0e..XOWNER/OPERATOR SIGNATURE SIGNATURE OF OWNERJOPERATOR DATE NAME OF OWNERJOPERATOR 1pnrtry TITLE OF OWNERlOPERATOR Permit Number(For focal uae ony) Permit Approved(Forhxal uae ony) Permit Eapiration Date(Forlow!use oNy) CUPAFORM(4199) Formerly SVVRC8 Form 8