COMPLIANCE INFO_2005-2008 - Laserfiche WebLink

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ST-Tank Form Page 2 Ip.51ructiol� ( 'ormerly SWRCB Permit Application Form { 1 Please number all pages of your submittal. 458. PIPING SYSTEM TYPE(UNDERGROUND)- For items 458 and 459, check the appropriate boxes to describe the type of product/waste piping installed in this tank system. Describe 459. PIPING SYSTEM TYPE(ABOVEGROUND)- underground and aboveground(if any)piping separately in the columns provided. 460. PIPING CONSTRUCTION (UNDERGROUND) - Check the appropriate box(es) to describe the type(s) of containment provided for the underground product/waste piping. 461. PIPING MANUFACTURER(UNDERGROUND)-Enter the name of the piping manufacturer. 462. PIPING CONSTRUCTION (ABOVEGROUND) - Check the appropriate box(es) to describe the type(s) of containment provided for any aboveground portions of the product/waste piping. 463. PIPING MANUFACTURER(ABOVEGROUND)-Enter the name of the piping manufacturer. 464. PIPING MATERIAL AND CORROSION PROTECTION (UNDERGROUND) - Check the appropriate boxes to describe the material(s) of construction of the primary(i.e. inner)underground product/waste piping and indicate whether any cathodic (i.e. corrosion)protection systems are installed. 465. PIPING MATERIAL AND CORROSION PROTECTION (ABOVEGROUND) - Check the appropriate boxes to describe the material(s)of construction of any primary(i.e. inner)aboveground product/waste piping and indicate whether any cathodic(i.e. corrosion)protection systems are installed. 466. PIPING LEAK DETECTION(UNDERGROUND)- For items 466 and 467, check the appropriate boxes to describe all leak detection method(s) used to comply with the monitoring 467. PIPING LEAK DETECTION(ABOVEGROUND)- requirements for regulated piping. 468. DATE DISPENSER CONTAINMENT INSTALLED-If the tank system is equipped with dispenser secondary containment(i.e. dispenser sumps or pans) equipment, enter the date that equipment was installed. If the tank system has a dispenser that is not secondarily contained,specify"None" in the space provided for the date. If the system does not include dispensers(e.g. standby generator tank system),enter"N/A." 469. DISPENSER CONTAINMENT TYPE - Check the appropriate box to describe how dispenser secondary containment is monitored for leaks. SIGNATURE OF OWNER/OPERATOR-The owner or an authorized agent of the owner shall sign in the space provided. This signature certifies that the signer believes that all information submitted is true,accurate,and complete. 470 DATE CERTIFIED-Enter the date the form was signed. 471. OWNER/OPERATOR NAME-Print or type the name of the person signing the form. 472. OWNER/OPERATOR TITLE-Enter the title of the person signing the form. 473. PERMIT NUMBER-This space is for agency use only. 474. PERMIT APPROVED BY-This space is for agency use only. 475. PERMIT EXPIRATION DATE-This space is for agency use only. UPCF hwfwrc-b(1/99)-4/4 http://www.unidocs.org Rev.02/16/00