Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS Tank #1 <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> Pae of <br /> VI.PIPING CONSTRUCTION(Check all that e I)) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 1.PRESSURE 0 2.SUCTION [13.GRAVITY 458. ❑L PRESSURE [12.SUCTION 0 3.GRAVITY 459. <br /> CONSTRUCTION/ OLSINGLE WALL 03.LINED TRENCH rjt 99.OTHER 460. ❑1.SINGLE WALL 095,UNKNOWN 462. <br /> MANUFACTURER 02 DOUBLE WALL 095.UNKNOWN 02.DOUBLE WALL 099.OTHER <br /> MANUFACTURER 461. MANUFACTURER 463. <br /> [�}1.BARE STEEL 0 6.FRP COMPATIBLE W[100%METHANOL [11.BARE STEEL [16,FRP COMPATIBLE W1100%METHANOL <br /> ❑2.STAINLESS STEEL 0 7.GALVANIZED MEL 0 2.STAINLESS STEEL [17.GALVANIZED STEEL <br /> ❑3.PLASTIC COMPATIBLE WITH CONTENTS 0 95.UNKNOWN [13.PLASTIC COMPATIBLE W/CONTENTS [18.FLEXIBLE(HDPE) [199.OTHER <br /> ❑4.FIBERGLASS [19,FLEXIBLE(HDPE) [199.OTHER [14.FIBERGLASS 0 9.CATHODIC PROTECTION <br /> ❑5.STEEL W/COATING [19.CATHODIC PROTECTION 464, 0 5.STEEL WICOATING 0 95.UNKNOWN 465. <br /> VIL PIPING LEAK DETECTION(Check dl0w a ly)(Adeccd tan ofOu amowing2rajmm shall be cubutmd to the local enc .) <br /> UNDERGROUND PIPING ABOVEGROUND FIFING <br /> SINGLE WALL PIPING 466, SINGLE WALL PIPING 467, <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> ❑1 NDETECTOR TESPUMP T <br /> E <br /> SHUT-OFFFOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION SHUT OFF FOR LAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION <br /> +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. <br /> 0 2. MONTHLY 0.2 GPH TEST 0 2. MONTHLY 0.2 GPH TEST <br /> [13. ANNUAL INTEGRITY TEST(0.1 GPH) [13. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> 04. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> [15. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 05+ DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW 07. SELF MONITORING <br /> [19. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): <br /> 08. DAILY VISUAL MONITORING <br /> [39, BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply)'. <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Check one) <br /> $)e. AUTO PUMP SHUT OF WHEN A LEAK OCCURS 0 a. AUTO PUMP SHUT OF WHEN A LEAK OCCURS <br /> $] <br /> Is.AUTO PUMP SHUT OF FOR LEAKS,SYSTEM FAILURE AND SYSTEM b. DISCONNECTION <br /> AUTO PUMP <br /> SHUT OF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION <br /> Oc. NO AUTO PUMP SHUT OF Oc. NO AUTO PUMP SHUT OFF <br /> 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 11 AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 013. CONTINUOUS SUMP SENSOR AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> 014. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF 014.CONTINUOUS <br /> VISUALSENSOR MSP' O AUTOPUMPSHUTOF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE <br /> ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> [316. ANNUAL INTEGRI"IY TEST(0.1 GPIG [116.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> [117 DAILY VISUAL CHECK 0 17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 468. 01. FLOAT MECHANISM THAT SHUTS OF SHEAR VALVE [34, DAILY VISUAL CHECK 469. <br /> DATE INSTALLED [12. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 05. TRENCHILINER MONITORING <br /> ;9I3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OF FOR 06. NONE <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> 1 certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF 0 IVOPEKAT DATE: 470' <br /> 6/17/03 <br /> 473 <br /> Dennis Cove UU . <br /> NAME OF OWNER/OPERATOR(print): TITLE OF OWNER/OCEI recto r <br /> Permit Number(Agency use only) 473. 1 Permit Approred By(Agency use only) 47T=-it Expiration Date(Agency use only) 475. <br /> UPCF hwNerc-b(I/99)-314 http://www.unidocs.org Rev.02/16/00 <br />