BILLING 2005 - 2007 - Laserfiche WebLink

Home Browse Search

If 0 ) D PROGRAM CONSOLIDATED F0 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE z Pae Z- of 2- VI.PIPING CONSTRUCTION(Check all that a I) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE 1.PRESSURE ❑2.�jD N ❑3.GRAVITY 45&. ❑1,PRESSURE 112.SUCTION 0 3.GRAVITY 459. CONSTRUCTION/ ❑ SINGLE WALL ❑3. TRENCH ❑99OTHER 460. ❑1.SINGLE WALLMANUFACTURER ❑95.UNKNOWN 462. 2.DOUBLE WALL ❑95OWN ❑2.DOUBLE WALL ❑99.OTHER MANUFACTURER 461, 1 MANUFACTURER 463. ❑I.BARE STEEL [16.FRP COMPATIBLE W/100%METHANOL ® I.13ARE STEEL ❑6.FRP COMPATIBLE W/100%METHANOL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL ❑}.PLASTIC COMPATIBLE WITH CONTENTS ❑95.UNKNOWN [33.PLASTIC COMPATIBLE WI CONTENTS C18.FLEXIBLE(HDPE) 13 99.OTHER 4.FIBERGLASS C18.FLEXIBLE(HDPE) 1199.OTHER [14.FIBERGLASS ❑9.CATHODIC PROTECTION ❑S.STEEL W/COATING ❑9.CATHODIC PROTECTION 464. ❑5.STEEL W/COATING ❑95.UNKNOWN 465. VII.PIPING LEAK DETECTION Check all that apply)(Ad . tion ofthe mriftorinj programshall be submined to the local a cnn .) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466. SINGLE WALL PIPING 467. PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that a ! ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WI AUTO PUMPDETECTOR Y)` PH TEST WITH AUTO PUMP SHUT-OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEMDIDISICONNECTION ❑1 SLHCTT OFF FDR LEAK,SYTEM FAILURE,GAND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. ❑2. MONTHLY 0.2 GPH TEST 112. MONTHLY 0.2 GPH TEST ❑3. ANNUAL INTEGRITY TEST(0.1 GPH) ❑3. ANNUAL INTEGRITY TEST(0.1 GPH) ❑4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) 0 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST(0.1 GPH) ❑S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): [36. TRIENNIAL INTEGRITY TEST(0.1 GPH) [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ❑7. SELF MONITORING 119. 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): �Y): 10. CONTINUOUS TURBINE SUMP SENSOR WM AUDIBLE AND VISUAL I0. CONTINUOUS TURBINE SUMP SENSOR WIT AUDIBLE AND VISUAL A1xARMS AND(Check one) ALARMS AND(Check one) a. 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 K ❑c. NO AUTO PUMP SHUT OFF ❑c. NO AUTO PUMP SHUT OFF 1. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR RESTRICTION ❑ 11. AUTOMATIC LEAK DETECTOR ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 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(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS [315. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TESD MaTHO FLOW SHUT OFF OR RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) [3 16. ANNUAL INTEGRITY TEST(0.1 GPH) [117. DAILY VISUAL CHECK C] 17. DAILY VISUAL CHECK Vlll.DISPENSER CONTAINMENT DISPENSER CONTAINMENT 468 ❑ I. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [34. DAILY VISUAL CHECK 469, DATE INSTALLED X2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5. TRENCHILINER MONITORING It .�Cy�j _ ❑3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 7` DISPENSER+AUDIBLE AND VISUAL ALARMS C3 b. NONE LY.OWNER/OPERATOR SIGNATURE I certify that the i rrnation provided herein is true and accurate to the best of my knowledge. SIGNATURE O ER/ PE DATE: 479 NAME OF OWNER/OPERATOR(print): TITLE OF OWNERJOPERATOR: d7= Permit Number(Agency use only) 473 Permit.approved By(Agency use only) 474. Permit Expiration Date(Agency use only) 475 UPCF hwfwre-b(1/99)-314 http./Iwww.unidacs.org Rev.0116100