BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

"r UNIFIED PROGRAM CONSOLIDATEc) FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI.PIPING CONSTRUCTION(Cheek ad that appy) - UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1, PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION D 3, GRAVITY CCNSTRUCTION/ ❑ 1. SINGLE WALL ❑ 3. LINED TRENCH ❑99 OTHER ❑ 1. SINGLE WALL ❑95. UNKNOWN MANUFACTURER 2. DOUBLE WALL ❑95. UNKNOWN ❑ Z DCUBLE WALL ❑99. OTHER MANUFACTURER f I1 MANUFACTURER ❑ 1.BARE STEEL ❑ 8, FRP COMPATIBLE W1100%METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE WI 1C0%METHANOL MATERIALS AND ❑ 2, STAINLESS STEEL Cl 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS `(�f"g 95. UNKNCVVN © 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE{HOPE} Cl 99. OTHER ❑ 4, FIBERGLASS ❑ S. FLEXIBLE(HOPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 9. CATHODIC PROTECTON ❑ 5. STEEL INI COATING ❑ S. CATHODIC PROTECTION ❑ S. STEEL Ail COATING ❑95. UNKNOWN VII.PIPING LEAK DETECTION(Check aR that appy) UNDERGROUND PIPING A80VEGROUND PIPING SJNGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check aI mat apply): PRESSURIZED PIPING(Chrck aN that apply): - IX 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK.SYSTEM FAILURE.AND SYSTEM DISCCNNECT90N+AUOISLE AND VISUAL SYSTEM FAILURE,AND SYSTEM CISCONNECTION+AUCIBLE AND VISUAL ALARMS ALAWAS ❑ 2. MONTHLY 0 2 GPM TEST ❑ 2. MC14THLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST{p.1 GPH) ❑ 3. ANNUAL INTEGRITY TEST(0 1 GPH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check al that apply): ❑ 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY ❑ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0 I GPH) ❑ 6. TRIENNIAL INTEGRITY TEST(0.1 GPM) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPIHG)r SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING ❑ T- S'cLF MONITORING GRAVITY FLOW- GRAVITY FLOW(Cheek alt that apply): ❑ 9. BIENNIAL INTEGRITY TEST 10 1 GPH) ! ❑ S. DAILY VISUAL MONITORING ❑ 9 BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(Check ax that appy)' PRESSURIZED PIPING(Chock all that apply): 10.. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check ane) an10.CONTINUOUS TURBINE SUMP SENSOR)AITH AUDIBLE AND VISUAL ALARMS AND(check e) Cl a AUTO PUMP SMUT OFF WHEN A LEAK OCCURS ❑ a_AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ h AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ D.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION Ip��1 O+SCONNECTION IJU c. NO AUTO PUMP SHUT OFF ❑ c NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC UNE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR ❑ 11 AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12- ANNUAL INTEGRITY TEST(U.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTIONIGRAVITY SYSTEM: SUCTIOWGRAVITY SYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR-AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check 84 that appy) EMERGENCY GENERATORS ONLY(Check ON that appJA ❑ 14- CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF.AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15 AUTCMATIC UNE LEAK DETECTOR(3.0 GPH TEST)!ATHCUT FLOW SHUT OFF OR ❑ IE_AUTOMATIC LINE LEA.X DETECTOR{3.p GPM TEST) R£STRTC'ON ❑ 1B. ANNUAL INTEGRITY TEST(0.1 GPH} ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ IT DAILY VISUAL CHECK . VUL DISPENSER CONYAINMEHT - DISPENSER CONTAINMENT L� 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4_ DAILY VISUALCHECK CATE INSTALLED 2..CONTINUOUS DISPENSER PAN SENSOR+AU0 BLE AND VISUAL ALARMS ❑ 5. TRENCH LINER I MONJTCRING A t i iy 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE ANO VISUAL ALARMS ❑ 6- NONE Ix.OWNERIOPERATOR SIGNATURE I eartrty that Me intpmauun provided herein is we and amrnte to the hast of my knowledge. 411 TUR F OWN OPERATOR DATE MM.O CW..ERIOPERA. OR(print) TITLE OF OWNER,CPERATOR L71 Numder(par k=41 use any) Permit Appooved(Far(mal uae only) Pemrit EApi-6w Date{Farlecat use aMy) CUPAFORM(4199) Formerly SVMCE FOrrn B