COMPLIANCE INFO_1999-2005 - Laserfiche WebLink

Home Browse Search

f �j �1 p� g NIIFED PROGRAM CONSOLIDATED TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Check all(hat apply) Page of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1.PRESSURE ❑2.SUCTION ❑3.GRAVTT'Y 458 ❑ L PRESSURE ❑2. SUCTION ❑3.GRAVITY 459 CONSTRUCTION ❑ I.SINGLE WALL. ❑3.LINED'TRENCH ❑99.OTHER 460 ❑1.SINGLE WALL ❑95.UNKNOWN 462 MANUFACTURER ®2.DOUBLE WALL ❑95.UNKNOWN ❑2.DOUBLE WALL ❑99.O'T'HER MANUFACTURER TELEFLEX 461 MANUFACTURER 463 ❑ I.BAIZE STEEL ❑6.ERP COMPATIBLE w/100% ME'I7IANOL ❑1.BARE STEEL ❑6.FRP COMPATIBLE W/loo/METHANOL ❑2.STAINLESS ST'EBI. ❑7.GALVANIZED STEEL I ❑Unknown ❑2. S'T'AINLESS STEEL ❑7.GALVANIZED STEEL, ❑3.PLASTIC COMPATIBLE W/CONTENT'S ❑99. Other ❑3. PLASTIC COMPATIBLE W/CONTENTS [18.FLEXIBLE(IfDPL') ❑99. OTHER ®4.FIBERGLASS [18.FLEXIBLE(HDPE) ❑4. FIBERGLASS ❑9.CATHODIC PRO'T'ECTION ❑5-STEEL W/COATING ❑9.CATHODIC PROTECTION 464 ❑5. STEEL W/COATING [195.UNKNOWN 465 VII.PIPING LEAK DETECTION(Check all that apply)(A description of the monitoring program shall be submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all that apply) PRESSURIZED PIPING(Check all that apply): ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPI I TEST WITM'1 AUTO PUMP SHUT ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPI I'IEST_Wfl'I I AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AM)VISUAL ALARMS. ❑2.MONTHLY 0.2 GPH'1'ES'T ❑2. MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) [13.ANNUAL INTEGRITY TEST(0.1 GPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL.SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑5.DAILY VISUAL.MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING WIEGRTTY TEST(0.1 GPH) ❑5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑6. 'TRIENNIAL INTEGRITY'1'ES'1'(0.1 GPH) ❑7.SELFMONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7. SIiLF MONITORING ❑9.BIENNIAL INTEGRITY TEST(0.T GPH) GRAVITY FLOW(Check all that apply) ❑8. DAILY VISUAL MONITORING ❑9, BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINFD PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check one) ALARMS AND(Check one) ❑a. AUTO PUMP SITUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUTOFF WHEN A LEAK OCCURS ❑b. AUTO PUMP SHUTOFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUTOFF OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ®c. NO AUTO PUMP SHUTOFF ❑c NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT ❑1 I AUTOMATIC LEAK DETECTOROFF OR RESTRICTION ® 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM STICTION/GRAVITY SYSTEM ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONL'INUOUS SUMP SENSOR i AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) EMF,RGENCY GENERATORS ONLY(Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF* ❑ 14. CONTINUOUS SUMP SENSOR WI THOU F AUTO PUMP SHUT OFF AUDIBLE AND VISUAI,ALARMS AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPI TEST)WITHOUT FLOW ❑15. AUTOMATIC LINE LEAK DETECTOR 3 0 GPH TfiST SHUTOFF OR RESTRICTION ( ) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPI I) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINNI N'r DISPENSER CONTAINMENT ® 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4.DAILY VISUAL Cl1ECK DATE INSTALLED 468 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5.TRENCH LINER/MONITORING 1998 ❑3-CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFE'FOR ❑6 NONL 469 DISPENSER+AUDIBLE AND VISUAL ALARMS A.OWNER/OPERA'T'OR SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. NATURE OF O R/OPERATOR DATE470 da 3 - 19-03 NAME OF OWNF OPRATOR(print) JITLF OF OWNER/OPERATOR -T 472 SANDY EDWARDS ca t Ie Perin Number(For local use only) 473 Permit Approved(For local use only) I Permit Expiration Date( local use only) 475 UPCF(1/99 revised) Formerly SWRCB Form B