BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

I UNIFIED PROGP,4,M CONSOLIDATED FORM UNDERGROUND STORAGE T -TANK PAGE 2 TANKS VI.PIPING CONSTRUCTION Cheetah thate I Page loot UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑I.PRESSURE UCTION ❑3.GRAVITY 459 ❑1.PRESSURE ,:. SUCTION ❑3.GRAVITY 459 CONSTRUCTION SINGLE WALL ❑3.LINED TRENCH ❑99.OTHER 466 SINGLE WALL ®95.UNKNOWN 462 MANUFACTURER❑2.DOUBLE WALL ❑95.UNKNOWN 0 2.DOUBLE WALL 1199.OTHER MANUFACTURER 461 MANUFACTURER ✓,q l 463 ❑1.BARE STEEL ❑6.FRP COMPATIBLE w/i00% METHANOL 0 L BARE STEEL Cl 6.FRP COMPATIBLE W/100%METHANOL ❑2.STAINLESS STEEL 0d,GALVANIZED STEEL ❑Uldmown ❑2.STAINLESS STEEL ®7.GALVANIZED STEEL ❑3.PLASTIC COMPATIBLE W/CONTENTS 1199. Other [13. PLASTIC COMPATIBLE W/CONTENTS ❑8.FLEXIBLE(HDPE) ❑99. OTHER ❑4.FIBERGLASS ❑8.FLEXIBLE(HDPE) ®4.FIBERGLASS ❑9.CATHODIC PROTECTION ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 464 ❑S.STEEL WlCOATINO ®95.UNKNOWN 465 VIL PIPING LEAK DECETTION Cluck ala tlut a A dwcti don of themonimr n stn shall be subtniued to the locale c UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING(check all that apply): PRESSURIZED PIPING(Check all that apply): ❑1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH IT ii AUTO PUMP SHUT ❑I. ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST WITH AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. SHUT OFF FOR LEAK SYSTEM FAII URE;AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. r-12.MONTHLY 0.2 GPH TEST [3 2.MONTHLY 0.2 GPH TEST ®3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) [14.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check an that apply) ❑S.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) ❑S.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ®6.TRIENNIAL INTEGRITY TEST(0.1 GPH) ❑7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7.SELF MONITORING [19.BIENNIAL IVT EGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): ❑S.DAILY VISUAL MONITORING 9.BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all That apply): PRESSURIZED PIPING(Cluck all that apply): 10. CONTINUOUS TURBINE SUMP SENSORWITH AUDIBLE AND VISUAL ]0. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Check one) ALARMS AND(Check one) ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT DISCONNECTION DISCONNECTION OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ®c.NO AUTO PUMP SHUT OFF Qo NO AUTO PUMP SHUT OFF ❑11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)=FLOW SHUT OFF OR RESTRICTION ❑11.AUTOMATIC LEAK DETECTOR ❑12. ANNUAL INTEGRITY TEST(0.1 OPH) [112.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(Chock all that apply) EMERGENCY GENERATORS ONLY(Check ail that apply) ❑14.CONTINUOUS SUMP SENSOR AUTO PUMP SHUT OFF° ❑14.CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL ALARMS -MTHOUT AUTO PUMP SHUT OFF ®.15...AUTOMATIC LINE.LEAK DETECTOR(3.0 OPH TEST))UTHOUT FLOW AUDIBLE AND VISUAL ALARMS SHUT OFF OR RESTRICTION ❑I5.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑17.DAILY VISUAL CHECK ®17.DAILY VISUALCHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ®4.DAILY VISUAL CHECK DATE INSTAL ED , 468 ®2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑S.TRENCH LINER/MONITORING [13.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑6.NONE 469 IX.OWNERIOPERATOR SIGNATURE I certify that the information provided Matin is we and accurate to the but.ofrny knowledge. SI ATURE OF 0 R/OPERA OR DATE470 1 �� N OF OWNER/ TOR(print47t TITLE OF OWNER/ PERATR 472 P�amit Ntunbet(For local use only) 4T3 Permit Approved(For local use onlyy 474 't Expiration Date(For tical use only) 475 IJPCF(12/99 revised) 12 Formerly SWRCB Form B