COMPLIANCE INFO_2010-2018 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TAM' UNDERGROUND STORAGE TANKS - TANK PAGE 2 Page or VL PIPING CONSTRUCTION (CheckalthatsmW USERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE t. PRESSURE ❑ 2 SUCTION ❑ 3. GRAVITY 458 ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 459 ❑ 1. SINE WALL ❑ 3 LINED TRENCH ❑ 99. OTHER 460 GL ❑ 1. SINGLE WALL ❑ 95. UNKNOWN 462 CONSTRUCTION/ MANUFACTURER Eh. DOUBLE WALLUNKNO ❑ 2. DOUBLE WALL ❑ 99. OTHER �C MANUFACTURER Y yy 461 MANUFACTURER 463 ❑ 1. BARE STEEL � FRP COMPATIBLE W/ 100% METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE W/ 100% METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL U 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION PROTECTION CTI PLASTIC COMPATIBLE WITH CONTENTS ❑ 95. UNKNOWN ❑ 3 ON ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ S. FLEXIBLE (HDPE) ❑ 99. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE (HDPE) ❑ 99. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑ 9 CATHODIC PROTECTION 464 10 5. STEEL W/ COATING, ❑ 95. UNKNOWN 465 VII. PIPING LEAK DETECTION (Check all tAatamW UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL P94NO 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that appy): PRESSURIZED PIPING (Chart all that appy): ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE .EAK DETECTOR 3.0 GPH 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 ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPH TEST ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check all that appy): ❑ & DALY VISUAL MONRGONG OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VLSUAL MONr7ORING OF PIPING AND PUMPING SYSTEM TEST (0.1 GPH) ❑ 6. TRIENNIAL INTEGR�TY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW (MOUND PIPING): SAFE SUCTION SYSTEMS 'NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW (Check at -tat appy): ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) ❑ 8. DAILY VISUAL. MONITORING ❑ 9. BIENNIAL INTEGRI-Y TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check Neat appy): PRESSURIZED PIPING ((--4xtt all that appy): 10. CONTINUOUS TURBINE SUMP SENSOR W4T- AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TUG31NE SUMP SENSOR W TH AUDIBLE AND VISUAL ALARMS AND (check (Check one) one) ❑ . AUTO PUMP SLANT OFF WHEN A LEAK OCCURS 1:1a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS AUTO PUMP SHUT OFF FOR LEAKS SYSTEM FAILURE AND SYSTEM . DISCONNECTION ❑ b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNEC : CN ❑ c. NO AUTO PUMP SHUT OFF ❑ C. NO AUTO P'_MP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR (3 0 GP- -EST) WITH FLOW SHUT OFF OR RESTRICTION ❑ 11. AUTOMATIC LEA,,=ETECTOR ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 12. ANNUAL INTEGR- TEST (0.1 GPH) SUCTIONtGRAVITY SYSTEM: ❑ 13 CONTINUOUS SUMP SENSOR -AUDIBLE Ado VISUAL ALARMS SUCTION (GRAVITY SYSTEM: ❑ 13. CONTINUOUS SUM? SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that appy) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AL;73 PUMP SHUT OFF + AUDIBLE AND EMERGENCY GENERATORS ONLY (Check al that appy) VISUAL ALARMS ❑ 14. CONTINUOUS SU1IJP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPI- -EST) WITHOUT FLOW SHUT OFF OR ALARMS ❑ RESTRICTION 15. AUTOMATIC UNE =.:K DETECTOR (3.0 GPM TESTI ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑ 16. ANNUAL INTEGRi'' TEST (0.1 GPH) ❑ 17 GAILY VISUAL CHECK ❑ 17. DAILY VISUAL C`` -;K VIU. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MEEK-'N;SM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ❑ 2. CONTINUOUS ZiSPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER" MONITORING 3. CONTINUOUS='SPENSER PAN SENSOR WTH AUTO SHUT OFF FOR DISPENSER + c _ ZIBLE AND VISUAL ALARMS ❑ 6. NONE .149 IX. OWNER/OPERATOR SIGNATURE I ceney tnat the information provided herein IS true am accurate to the best of my knowledge. S TURE O E PERATOR DATE ; ®, 470 Al' (/1 l212 NhMF OF OWNERIOPERAT h0 471 TITLE OF OVINERIOPE?AT a'2 lt� 1Vk4Ae Permit Number (For local use only) 473 Fe -n Approved (For local use only) 474 1 Permit Expiration Date (For local use only! A UPCF (1/99) Formerly SWRCB Fr B