BILLING PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 0 VI.PIPING CONSTRUCTION(Check all mat apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 2111, PRESSURE ❑ 2. SUCTION ❑ 3 GRAVITY ❑ 1 PRESSURE ❑ 2. SUCTION ❑ 3 GRAVITY CONSTRUCTION/ ❑ 1. INGLE WALL ❑ 3 LINED TRENCM [:199 OTHER ❑ 1 SINGLE WALL C195. UNKNOWN MANUFACTURER DOUBLE WALL C ❑95 Y-NOWN, ,c` ❑ 2. DOUBLE WALL C199. OTHER MANUFACTURER 4 ;IV,"0, V'CO O MANUFACTURER ❑ 1 BARE STEEL - ❑ E FRP COMPATIBLE WI 100%METHANOL ❑ 1. BARE STEEL ❑ & FRP COMPATIBLE W/100%METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION PROTECTION C1 3 PLASTIC COMPATIBLE WITH LATENTS ❑95 UNKNOWN El PLASTIC COMPATIBLE WITH CONTENTS C18 FLEXIBLE(HOPE) ❑99 OTHER ' C34 FIBERGLA 55 B. PLEX18LE(MOPE) ❑99. OTHER. ❑ 4 FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 5 STEEL WI COATING ❑ 9. UTHOOIC PROTECTION ❑ 5. STEEL W/COATING ❑95. UNKNOWN VII.PIPING LEAK DETECTION(CMck all that appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Chat*as that apply): PRESSURIZED PIPING(Check W that aptly)' ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK,SYSTEM FAILURE.AND SYSTEM OISCONNECTION•AUDIBLE AND VISUAL SYSTEM FAILURE.AND SYSTEM DISCONNECTION•AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2. MONTHLY 0 2 GPM TEST ❑ 3. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST(0 1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS(Chock ad that aPPM: CONVENTIONAL SUCTION SYSTEMS. ❑ 5. DAILY VISUAL MONITORING Of PUMPING SYSTEM•TRIENNIAL PIPING INTEGRITY ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST 10 1 GPM) ❑ 8. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING) ❑ 7. SELF MONITORING ❑ 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW(Check aA that apply): ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) ❑ E. OAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(O.1 GPM) SECONDARILY CONTAINED PIPING SECONOARILY CONTAINED PIPING PRESSURIZED PIPING(Check eat that appy).' PRESSURIZED PIPING(Check a9 that apply)' 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND([heck orn) Cn one) AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OfF WHEN A LEAK OCCURS r ❑ D AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ D. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION 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 ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0 1 GPM) SUCTIONIGRAVITY SYSTEM SUCTIONIGRAV17Y SYSTEM: ❑ 13 CONTINUOUS SUMP SENSOR•AUDIBLE ANO VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check all that appy) EMERGENCY GENERATORS ONLY(Check a/that&RPM ❑ 14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF•AUDIBLE AND ❑ 14 ALARMS CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SMUT OFF•AUDIBLE AND VISUAL VISUAL ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WTHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST) RESTRICTION ❑ 111. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ td.ANNUAL INTEGRITY TEST(0.1 GRH) - _.._._ C317. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIIL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1 LOAT MECHANISM THAT SMUTS OFF SHEAR VALVE - _ ❑ 4. DAILY M UNEUAL CHECK DATE INSTALLED CONTINUOUS DISPENSER PAN SENSOR•AUDIBLE AND VISUAL ALARMS - ❑ 0. TRENCM LINER/MONITORING ❑ 3. CONTINLK)US DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER•AUDIBLE ANO VISUAL ALARMS ❑ 0. NONE OL OWNERIOPERATOR SIGNATURE 1 car9ly mat the"ormaeon pno sdoC homm is t1Ne AM SCCLr Ia to IM bast 01 my ktlowaeope. - jt C �..�� SIGNATURE OFOWNERIOPERATOR t' '-Es -7 DATE NA iD�� MATO (pant) - TITLE OF ONMER/OP RAT R 1(I,. IC. D;v�t�� tj A Po-'t A b For loin u3e only) PerrM E3praealo n Ogle IFor cst us•only) Pertrn1 Number(For/ocat uae omy) PWa'r c P.Iv SWRCF Form 13