COMPLIANCE INFO_1986-2004 - Laserfiche WebLink

Home Browse Search

r UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 V_t,PIPING,CONSTRfJCT10N'(C(Ieekapthat apply) Pace ofy UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1. PRESSURE 2. SUCTION " 3. GRAVITY ❑ 1, PRESSURE 2. SUCTION ❑ 3. GRAVITY CONSTRUCTION/ ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑99. OTHER ' 1. SINGLE WALL MANUFACTURER K2. DOUBLE WALL ❑95. UNKNOWN ❑95. UNKNOWN MANUFACTURER DOUBLE WAIL ❑99. OTHER MANUFACTURER ❑ 1.BARE STEEL ❑ 6. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARE STEEL MATERIALS AND ❑ 2. STAINLESS STEEL C17. GALVANIZED STEEL ❑ 6. FRP COMPATIBLE WI 100%METHANOL CORROSION ❑ 2.STAINLESS STEEL ❑ 7. GALVANIZED STEEL PROTECTION �y❑{ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN 113. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE(HDPE) ❑99. OTHER LAI 4. FIBERGLASS 11 8. FLEXIBLE(HDPE) 1199. OTHER 114. FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ S. STEEL W/COATING ❑ 9. CATHODIC PROTECTION ❑ S. STEEL W/COATING ❑95. UNKNOWN VII.PIPING LEAK DIETE'CTION(Check off that apply) UNDERGROUND PIPING SINGLE WALL PIPING ABOVEGROUND PIPING 0PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply):SI NGLE WALL PIPING 1 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK 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 C `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 apply): 4 S. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) ❑ 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): 7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING GRAVITY FLOW: ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): ❑ 8. DAILY VISUAL MONITORING El9. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check alf that apply): SECONDARILY CONTAINED PIPING 10. CONTINUOUS TURBINE SUMP SENSOR WITH - PRESSURIZED PIPING(Check all that apply): AUDIBLE AND VISUAL ALARMS AND (Check one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) 0,.. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS DISCONNECTION ❑ b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ C. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OfF OR RESTRICTION ❑ 11. AUTOMATIC LEAK DETECTOR 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that apply) ❑ EMERGENCY GENERATORS ONLY(Check all that appl)) 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ALARMS ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 18. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK 0004 OFF �2. CONT NUOUSADISPENSER PAN 3ENSORHF {5 DISPENSER CONTAINMENT VALVE �@T ❑ 4, PALLY VISUAL CHECK DATE INSTALLED ;.'.L AUDIBLE AND VISUAL ALARMS ❑ 5. TRENCH LINER/MONITORING 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑ 6. NONE IX.OWNERIOPERATOR SIGNATURE I certify that l formation provided herein is true and accurate to best of my knowledge. SIGNA E F OW1;�ER/' RATOR �j� DATE NA OF O ER/OPERAT R(print) TITLE Of OWNEWOPERATOR Permit Number(Forlocaf use onty) Permit Approved(For local use onty) PertnR F�pira6on Data(Forlora/use only) CUPAFORM(4199) Formerly SWRCS Form 8