COMPLIANCE INFO_2002-2012 - Laserfiche WebLink

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CoNsoLMATM FORM TANKS P of E 0""I" VL PIPING CONSTRUCTION anem UNDERGROUNDPIPING ABOVEGROUND PIPING SYSTEM Q 1. SURE 2.SUCTION ❑3.GRA 458 D 1.F ❑2 ON 3.GRAVITY a59. CON UCTION/ D 1.SINGLE WALL ❑3. H Q 99.0 4b0. D I.SINGLE WALL ❑95.UNKNOWN 462 MANUFCTURER ATHER LE WALL 1345. 2.DOUBLE WALL ®91.O MANUFACTURER 461. A 463. 6 FRP COMPATIBLE WPI i. ❑1.BARE D 6. COMPATIBLE w/1 METHANOL 13 1• STEEL Q7 GALVANIZEDSTEEL Q Z.ST STEEL ❑7.GALVANIZEDSTEEL Q 2.STAINLESS 13 D 3.PLASTIC COMPATIBLE WITH Co ❑95.UNKNOWN Q 3.PLAS71C COMPATIBLE WF CONTENTS D S.FLEXIBLE(HDPE) ❑99.OTHER, 4.FIBERGLASS ❑8.FLEGBLE(HDPE) ❑99.OTHER ❑4.FIBERGLASS ❑9.CATHODIC PROTECTION D S.STEEL w/COATING D 9.CATHODIC PROTECTION 464. 1 [15. L w/COATING Q 95.UNKNOWN VII.PIPING LEAK nON ocksllftia )(A oftm- -- -AmIlbesubmitWitottelwal ) UNDERGR4 PIPING OUND PIPING SING W PIPING 466. SINGLE W PIPING 467. PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): Q 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMp ❑1. ELECTRONIC LINE LEAK D FAILUREFOR LEAK.SYSTEM R 3.0 GPH TEST WITH AUTO PUMP AND SYSTEM ON SHUT-OFF FOR SY FAIL SYSTEMON S OFF +AUDIBLEANDVISUAL +AUDIBLE AL S. p z MONTHLY o.2 GPH TEST 02. MONTHLY a.2 GPH TEST 03, AL TY TEST{o.l GPH} (33. AL TY TEST(0.1 [34. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) Q 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING Q 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM MTEGRITY'TEST(0.1 GPH) SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑6- L G TEST(0.1 GPH) 7. SELF MONITORING SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): W Q 7. SELF MONITORING GRA [39. BI IIN1'EG TEST(0.1 GPH) GRAVITY W{ all that apply). ❑S. DAILY VISUAL MONITORING Q 9. BIENNIALINTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING( k all that apply)- 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE ANDVISUAL 10. CONTINUOUS(Check AND INE)SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS (Check one) LEAK OCCURS Q a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a. AUTO PUMP SHUT OFF WHEN A Q b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b.AUT®PUMF SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑c. NO AUTO PUMP SHUT OFF Qc. NO AUTO PUMP SHUT OFF D 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH FLOW SHPT ®11.AUTOMATIC LEAK DETECTOR OFF OR RESTRICTION Q 12. AL RTTY TEST(O.i GPH) D 12. AL TY TEST(0.1 GPH) EM SUCTIONIGRAVITY SYSTEM S OxhGAA sYs1 I3. OUS S SENSOR+AUDIBLE VISUAL S D 13.CONTINUOUS SENSOR+AUDIBLE VISUAL S EMERGENCY GENE Y(G all apply) EMERGENCY GENERATORS ONLY( all apply) D 14. CONTINUOUS SUMP sENsoR AUTO PUMP SHUT OFF ®14-CONTINUOUS vI3U SEN ALARMS AUTO P SHUT OFF AND AUDIBLE AND VISUAL ALARMS D Is. AUTOMATIC Low LEAK D (3.0 GPH TEST) OUT w Q 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION IN113GRITY TEST(0-1 GPH) Q 16 AL TEST(0.1 GPH} D 16. AL Q 17. DAILY VISUAL C D 17.DAILY VISUAL CHECK VIIL DISPENSER CONT NT DISPENSER CONTAINMENT 46a. ❑L FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4. DAILY VISUAL CHECK 469. DATE U49T s, g23. CO OUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL S [35• MO RING �rj DU CONTINUOUS DISPENSER PAN SENSOR WITH� AUTO SHUT OFF FOR D 6. NONE 66 DISPENSER+AUDIBLE AND VISUAL ALARMS IX nvvmwu1nPVRAT0R SIGNATU I certify that the' ation gro Itetei to the best of my knowT 470. SIGNATURE OF EMPERATOR DATE: 472- NAME 7ZN O O P }: TITLE OFO P . ® 4 Peetnit N (A only) 473. t Appmwd By( only) 474. 1 P ' n Date(Agency use only) 475. e-b(1 )-3/4 6 J rg Rev.82/1 UPCF b