BILLING_1997-2003 - Laserfiche WebLink

Home Browse Search

mow UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VL PIPING CONSTRUCTION(CMckaftataWlyl . UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE Y,. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3.GRAVITY CONSTRUCTIONI ❑ 1. INGLE WALL El3. LINEDTRENCH [IN. OTHER ❑ 1. SINGLE WALL 11 N. UNKNOWN - MANUFACTURER �= DOUBLE WALL 1195. UNKNOWN •�Wy[IrDOUBLE WALL 1:199. OTHER MANUFACTURER F' j%IltC�b� MANUFACTURER ❑ 1.BARE STEEL 11B. FRP COMPATIBLE W/100%METHANOL ❑ 1. BARESTEEL 1:16. FRP COMPATIBLE WI 100%METHANOL MATERIALS AND ❑ 2.STAINLESS STEEL 11 7.7. GALVANIZED STEEL ❑ 2. STAINL CORROSION ❑ T.GALVANIZED STEEL - PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS 1195. UNKNOWN ❑ 3. PLASTICCOMPATIBLEWITHCONTENTS ❑ B. FLEXIBLE(HOPE) ❑99. OTHER ' ❑ 4. FIBERGLASS ❑ B. FLEXIBLE(HDPE) LV99. OTHER ❑ 4. FIBERGLASS ❑ 9.CATHODIC PROTECTION ❑ 5. STEELWICOATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL WICOATING 1195. UNKNOWN VII.PIPING LEAK DETEC71ON(Chock all that appy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING SINGLE WALL PIPING PRESSURIZED PIPING(Check alithef appy) PRESSURIZED PIPING(CMck all Mal appy): 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM 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 DISCONNECTION+AUDIBLE AND VISUAL SYSTEM FAILURE,AND SYSTEM DISCONNECTIONIAUDIBLE AND VISUAL ALARMS ALARMS 112. MONTHLY 0.2 GPM TEST ❑ 2. MONTHLYG _ 113.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 3.ANNUAL INTEGRITY TY TTESEST(0.1 GPM) ❑ 4. DAILYVISUALCHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(CMck e9Pal appy): _ ❑ S. DAILY VISUAL MONITORING OF PUMPING SYSTEM-TRIENNIAL PIPING INTEGRITY ❑ 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPM) ❑ B. 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(Cnsck an fMtappW: ❑ B. BIENNIAL INTEGRITY TEST IDI GPM) ❑ B. DAILY VISUAL MONITORING - ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING(DMCk all that appy): PRESSURIZED PIPING(ClutO a9 that appy): - 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Orgy one) %CONTINUOUS TURBIFlE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(Neck one) LWIt�AUTO PUMP SHUT OFF MEN A LEAK OCCURS ❑ a. AUTO PUMP SHIT OFF MEN A LEAK OCCURS - b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION 13b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION ❑ c. NO AUTO PUMP SHUT OFF 11c. NOAUTO PUMP SHUT OFF I t.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11.AUTOMATIC LEAK DETECTOR ❑ 12.ANNUAL INTEGRITY TEST(DI GPM) - ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPM) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITYSYSTEM: ❑ 13. CONTINUOUS SUMP SENSOR i AUDIBLE AND VISUAL ALARMS ❑ 13, CONTINUOUS SUMP SENSOR•AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Chack M Ml appy) EMERGENCY GENERATORS ONLY(Check ad that apply) 11 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND ❑ 14,CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF a.AUDIBLE AND VISUAL VISUALALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST)WITHOUT FLOW SHUT OFF OR ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPM TEST) RESTRICTION ❑ 19.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 18.ANNUAL INTEGRITY TEST(0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK V ll.DISPENSER CONTAINMENT ar DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4 DAILY VISUAL CHECK DATEINSTALLED 132. CONTINUOUS DISPENSER PAN SENSOR.AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING ay rs. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑ e. NONE IX.OWNERIOPERATOR SIGNATURE I Panay IMP Ne inkmnation pmMaaO herein is true aM...N,to ma best of MY knoMeE9e. SIGNATURE OF OWNERIOPERATOR - DATE NAME OF OWNER/OPERATOR(pnn0 TITLE OF OWNERIOPERATOR Permit limber(Forhral use any) Pnmit APpmvea(F fteleseony) PormIt E�inbon Date(Forklcel uxa M*) CUPAFORM(4/99) Formerly SWRCS Form B