COMPLIANCE INFO_2002-2008 - Laserfiche WebLink

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0 UNDERGROUND PIPING SYSTEM TYPE ® 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY CONSIRUMION ❑ I. SINGLE WALL ❑ 3. LINED TRENC11 ❑ 99. OTHER MANUFAC-11MER ® 2. DOUBLE WALL ❑ 95 UNKNOWN MANUFACTURER TELENLEX ❑ 1. BARE, STEEL ❑ 6. FRI' COMPATIBLE w/100% METHANOL. ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL (❑ Unknown ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS ❑ 99 Other ® 4. FIBERGLASS ❑ 8. FLEXIBLE (HDPE) ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROT'ECT'ION 464 ABOVEGROUND PIPING 458 ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 460 ❑ 1. SINGLE WALL ❑ 95. UNKNOWN ❑ 2. DOUBLE WALL ❑ 99. OTHER 461 MANUFACTURER ❑ 1. BARE STEEL ❑ 2. STAINLESS STEEL. ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS ❑ 4. FIBERGLASS ❑ 5. STEEL W/COATING all that SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply) ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPI I TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPH) CONVEN'T'IONAL SUCTION SYSTEMS ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+ TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION S YSTEMS (NO VALUES IN BELOW GROUNDPIPING): ❑ 7 SELF MONITORING GRAVITY FLOW ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CON'T'AINED PIPING PRESSURIZED PIPING (Check all that apply) 10. CONTINUOUS TURBINE. SUMP SENSOR WITH AUDIBLE AND VISTJAL ALARMS AND (Check one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION Sc. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINT: LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFT OR RESTRICTION ® 12. ANNUAL INTEGRITY T'ES"T (0.1 GPH) SUCTION/GRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SI1UT OFF OR RESTRICTION ❑ A of the mor Loring program shall be TANK Page of 459 462 463 ❑ 6. FRP COMPATIBLE W/l 00% METHANOL ❑ 7. GALVANIZED STEEL ❑ 8. FLEXIBLE (HDPE) ❑ 99 OTHER ❑ 9. CATHODIC PRO'TEC'TION ❑ 95. UNKNOWN 465 ted to die local agencv.) SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): ❑ L ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST Wl'I'}I AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INI`EGRITY TEST (0.1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 6. 'TRIENNIAL INTEGRITY IT ST (0.1 GPH) SAFE STICTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING) ❑ 7. SELF MONITORING GRAVI'T'Y FLOW (Check all that apply): ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0. I GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ h AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c NO AUTO PUMP 31IU'I' OFF ❑ 11. AUTOMATIC LEAK DETECTOR ❑ 12. ANNUAL INTEGRI'T'Y TEST (0.1 GPH) Sl1CTION/GRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP Sl1UT OF],'* AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPI TE'S'T') 16. -Al, INTEGRITY TEST (0.1 GPH) ❑ 16. ANNUAL INTEGRITY TEST (0 1 GPH) ❑ 17- DAILY VISUAL CHECK I ❑ 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT' ® 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ❑ 2. CON'T'INUOUS DISPENSER PAN SENSOR t AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER / MONIT'ORING 1995 ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑ 6 NONE' DISPENSER AUDIBLE AND VISUAL ALARMS 469 IX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. .,. ., ..... ,.;.�.. vn _. DATA cis __I NAME OF OWNS OPRATOR (print) ITLE OF OWNER/OPFRATOR _ SANDY EDWARDS ,� d Permit Nwnber (Por local use only) 473 permit Approved (For local use only) Permit local use 470 UPCF (1/99 revised) Formerly SWRCB Form B