COMPLIANCE INFO_2004-2009 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 I UNDERGROUND PIPItiG VI.PIPING CONSTRUCTION(shack aW mat appy) SYSTEM TYPE - ABOVEGROUND PIPING I. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION CON57RUCTIOW C11.SINGLE'NALL 113. UNEO TRENCH ❑99 OTHER C11. SINGLE WALL ❑ 3. GRAVITY MANUFACTUREP, ❑95.UNKNOWN 34- COUBLE WALL ❑45. UNKNOWN ❑ 2. DOUBLE VlALL MANUFACTURER ❑S9. OTHER MANUFACTURER ❑ I.BARE STEEL ❑ 6. FRP COMPATIBLE W/100%METHANOL ❑ 1, BARE STEEL MATERIALS AND ❑ 2 STAINLESS STEEL ❑ 7.GAWANIZED STEEL ❑ 6. FRP COMPATIBLE W/100%METHANOL CORROSION ❑ 2. STAINLESS STEEL 13 7.GALVANIZED STEEL PROTECTION ❑ 3 PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ S. FLEXIBLE(HOPE) ❑99. OTHER . FIBERGLASS ❑ 8. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 5 STEEL Vp COATING ❑ 9.CATHOOIC PROTECTION 11 4. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑95. UNKNOWN. VII.PIPING LEAK DETECTION(Check all that apphy) ' UNOERGROUNDPIPING SINGLE WALL PIPING ABOVEGROUNO PIPING PRESSURIZED PIPINGSINGLE WALL PIPING (CeKk as trat appty): PRESSURIZED PIPING(Creek all tRata ❑ 1. ELECTRONIC UN= PPy)' LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK. LEAK,SYSTEM FA;LURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS SYSTEM FAILURE.AND SYSTEM DISCONNECTION;AUDIBLE AND VISUAL ALARMS ❑ 2. MONTHLY 0.2 GPH TEST ❑ 2. MONTHLY 0 2 GPH TEST ❑ 3. ANNUAL INTEGR:7Y TEST(0 1 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCT,C!J SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply): ❑ 5 DAILY VISUAL M�NITORI!iG OF PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0 1 GPM; ❑ 6. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(,y0 VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONI70R':NG SAFE SUCTION SYSTEMS(NO VALVES IN BELOWGROUNO PIPING): GRAVITY FLOW ❑ 7. SELF MONITORING � ❑ 9. BIENNIAL IN rEGR,7Y TES'(0 1 GPM) GRAVITY FLOW(Check alr that appy): ❑ S. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CON TAI!.EO PIPING PRESSURIZED PIPING(CrecR as that apply): SECONDARILY CONTAINED PIPING PRESSURIZEO PIPING(Check all that appy): 10. CONTINUOUS TLR31NE SUN?SENSOR WITH AUDIBLE ANO VISUAL ALARMS AND (Check one) 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check one) ❑ a AUTO PL'JP SMUT CFF WHEN A LEAK OCCURS AUTO PL•.o SHUT CFF FOR LEAKS.SYSTEM FAILURE AND SYSTEM ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS D'SCONNF_T!ON ❑ D. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑c. NO AUTO P',;mP Sr.U7 OFF ❑ C. NO AUTO PUMP SMUT OFF ❑ 11. AUTOMATIC LIN_LEAP.0=-T= TOR(3.0 GPM TEST)VdiH FLOW SMUT OFF OR RESTRICTIOPJ ❑ 11 AUTOMATIC LEAK DETECTOR i ❑ 12. ANNUAL INTEGRITY TEST(C 1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) SUCTIONIGRAVITY SYSTEM SUCTION/GRAVITY SYSTEM; ❑ 13. CONTINUOUS SstP SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chock all mat apply) ❑ 14. CONTINUOUS S'.MP SENSCR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND EMERGENCY GENERATORS ONLY(Check an that apply)VISUAL ALARMS ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF-AUDIBLE AND VISUAL 11 1 S.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)V41THOUT FLOW SHUT OFF OR ALARMS RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) ❑ /6.ANNUAL INTEGR:7Y TEST(0.1 GPM) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17.DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIIL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE HECK DATE INS7AlLEp ❑ 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑S.4.DAILY HLINEVISUAL /MONITORING 1�, - jyC ❑ S. TRENCHUNER/MONItORtNG CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6.NONE IX.OWNER/OPERATOR SIGNATURE I Certlty mat me inlama:cn provided hanin is true and aaa,nt to .e best or my knowledge. SIGNATURE OF OWNEROPERATOR e DATE � NAME OF OWNER(OPEFATOR(prtrq C J TITLE OF OWN ROPERA R Permit NumJer(forlacat use orly) Pemdt Approved(Forlecel use only) Permit Expiration Date(Forleca/use only) CUPAFORM(4/99) Formerly SNiRCB Forrn 8