BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI.PIPING CONSTRUCTION Cbeekall mat. I page f UNDERGROUND PIPING I ABOVEGROUND PIPING SYSTEM TYPE 0 I.PRESSURE 2.SUCTION 0 3.GRAVITY 458 1 0 I.PRESSURE 0 2. SUCTION 0 3.GRAVITY 459 CONSTRUCTION V I.SINGLE WALL 0 3.LINED TRENCH [199.OTHER 460 01.SINGLE WALL 0 95.UNKNOWN 463 MANUFACTURER 0 2.DOUBLE WALL 0 95.UNKNOWN 0 2.DOUBLE WALL 0 99.OTHER MANUFACTURER 461 MANUFACTURER 463 0 1.BARE STEEL 0 6.FRP COMPATIBLE w/100% METHANOL 0 1.BARE STEEL [:16.PRP COMPATIBLE Wll W o METHANOL [12.STAINLESS STEEL 0 7.GALVANIZED STEEL D Unknown [12. STAINLESS STEEL [17.GALVANIZED STEEL 0 3.PLASTIC COMPATIBLE W/CONTENTS [199. Olhes [13. PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEXIBLE(HDPE) 099. OTHER 1y 4.FIBERGLASS 0 S.FLEXIBLE(HDPE) [14. FIBERGLASS [19.CATHODIC PROTECTION LLJ 5.STEEL W/COATING 0 9.CATHODIC PROTECTION 464 0 5. STEEL W/COATING [195.UNKNOWN 465 VII.PIPING LEAK DETECTIONChmkall that I Adesctition of the monliorin poomot shell be submitted to the localene. UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING(Check all Ih eapply): PRESSURIZED PIPING(Check all that apply): ❑I.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ SHUT OFF FOR LEAK SYSTEM FAILURE,AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. 0 2.MONTHLY 0.2 GPH TEST [12. MONTHLY 0.2 GPH TEST 0 3.ANNUAL INTEGRITY TEST(O.IGPH) [13.ANNUAL INTEGRITY TEST(0.1 GPH) [14. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENT10NAq SUCTION SYSTEMS(Catchall that apply) �5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) I D S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): 0 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) 0 7.SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW 07. SELF MONITORING 0 9.BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLON^I(Check all that apply): 08. DAILY VISUAL MONITORING [19. BIENNIAL(INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Oh«k 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(Check one) ALARMS AND(Check we) 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS D b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION Dc. NO AUTO PUMP SHUT OFF Oc NO AUTO PUMP SHUT OFF ❑11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT 0 11 AUTOM�TIC LEAK DETECTOR OFF OR RESTRICTION ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUALINTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS 013. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Ch«k all that apply) EMERGENCY GENERATORS ONLY(Cook all d u apply) D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF• 0 14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLQ AND VISUAL ALARMS [115. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW 015. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) SHUT OFF OR RESTRICTION [116.ANNUAL INTEGRITY TEST(0.1 GPH) 0 16.ANNUAL INTEGRITY TEST(0.1 GPH) 0 17. DAILY VISUAL CHECK 0 17. DAILY VISUAL CHECK VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4.DAILY VISUAL CHECK DATE INSTALLED 468 ❑2.CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS 0 5.TRENCH LINES/MONITORING ❑3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6.NONE 469 DISPENSER+AUDIBLE AND VISUAL ALARMS IX.OWNER/OPERATOR SIGNATURE I certify that he information provided herein is nue andaccumm to the best of my knowledge. NATURE OF OWNEWPERATIOR DATE 470 AMEOFO OPRATOR(p' t) 471 O OW=) OPE T �& 473 1 Permit Number(F local use only) 473 Permit Approved(For local use only) t 474 Permit Expiation Dete(For local use only) 475 UPCF(12/99 revised) 12 Formerly SWRCB Form B