BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

�IFIED PROGRAM CONSOLIDATED FOR46 TANK: TA0506699 R#: PR0231485 UNDERGROUND STORAGE TANKS - TANK PAGE AC#: FA0000306 VL PIPING CONSTRUCTION(cnmk all 1Nt apply) PMc 5 of7 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1.PRESSURE ❑ 2.SUCTION ❑3.GRAVITY 458 ❑ L PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY 459 CONSTRUCTION ❑1.SINGLE WALL ❑3.LINED TRENCH ❑ 99.OTHER 460 ❑ I.SINGLE WALL [195.UNKNOWN 462 h9l;.DOUBLEWALL ❑95.UNKNOWN El 2.DOUBLE WALL El 99.OTHER MANUFACTURER Arl5'� 461 MANUFACTURER 465 ❑ 1.BARE STEEL ❑ 6.FRP COMPATIBLE w/IN%METHANOL ❑ I.BARE STEEL ❑ 6.PEP COMPATIBLE W 100%METHANOL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN 4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER ❑ 4.FIBERGLASS [18.FLEXIBLE(HDPE) ❑99.OTHER ❑ 5.STEEL W/COATING ❑9.CATHODIC PROTECTION 464 [15.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 465 VO.PIPING LEAK DETECTION((Mck a8 that apply)(A d Mpuw oftlamoniwrm8 pm8ram a1m11haabmitW w the tool agmry.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PeING a67 PRESSURIZED PIPING(Check all that apply): 466 PIPING(Check all that apply): ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ L ELECTRONIC LME LEAK DETECTOR3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS. VISUAL ALARMS. ❑ 2.MONTHLY 0.2 GPH TEST ❑3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 2.MONTHLY 0.2 GPH TEST ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) ❑4.DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) ❑ 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING ❑ 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST(0.1 GPH) ❑ 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): ❑ 7.SELF MONITORING GRAVITY FLOW ❑ 7.SELF MONITORING ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH GRAVITY FLOW(Check all that apply): ❑ 8.DAILY VISUAL MONITORING ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL - 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(C oa) ALARMS AND(Clack one) �91a.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 OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF ❑ C.NO AUTO PUMP SHUT OFF 11. IC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR -RESTRICTION ❑ 11 AUTOMATIC LEAK DETECTOR IN 2.ANNUAL INTEGRITY TEST(0.1 CPM ❑ 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(Claek all that appy) EMERGENCY GENERATORS ONLY(Chwk au that apply) ❑ 14.CONTINUOUS SUMP SENSOR WITH UT AUTO PUMP SHUT OFF e ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ❑ 15.AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ 15.AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ V.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK VUL DISPENSER CONTAINMENT DISPENSER CONTAINMENT1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INS T ED E]4.DAILY VISUAL CHECK t 468 2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑ 6.NONE DISPENSER+AUDIBLE AND VISUAL ALARMS 469 IX.OWNER/OPERATOR SIGNATURE I certify Nal the m(tion pmherein istmcaM arcwaw to the tnel ofmy krowlcdae. SIGNATURE OF OWNER/OPERATORDATE 406 NAME OF OWNERIOPERATOR(p im) TITLE OF OWNER/OPERATOR 471 472 PcmlNmMc(Forbalusemly) 473 Pmnit Appmmd(For foal use Dory) 474 F.it Expiration Date(For brat uae only) 47$ PT0000313 EE0000817 6/30/2003 UPCF(12/99 revised) 0 0