BILLING 1985-2004 - Laserfiche WebLink

Home Browse Search

UNrFIND PROGRAM CON30LIDATJI) FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANKS P a V!.PIPING CONSTRUCTION(Chock u tnat apply) UNDERGROUND PIPING SYSTEM TYPE ABOVEGROUND PIPING fJ I, PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY_ 4511 ❑ 1. PRESSURE ❑ 1. SINGLE WALL ❑ 3. LINEOTRENCH ❑g9, OTHER 4110 ❑ 1. SINGLE WALL ❑ SUCTION ❑ 3. GRAVITY 459 CONSTRUCTIOW� ❑ . MANUFACTURER U 2, DOUBLE W ❑ALL ❑45. UNKNOWN 2. OOUBLE WALL ❑9599. OTHER UNKNOWN 46, MANUFACTURER 461 MANUFACTURER ❑ 1.BARE STEEL 6. FRP COMPATIBLE Wf 100%METHANOL ❑ I. BARE STEEL 463 MATERIALS AND ❑ 2. STAINLESS STEEL ❑ 7, GALVANIZED STEEL ❑ 6. FRP COMPATIBLE Wl 100%METHANOL CORROSION ❑ 2. STAINLESS STEEL ❑ P. GALVANIZED STEEL PROTECTION 3. PLASTIC COMPATIBLE WITH CONTENTS ❑95. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ a. FLEXIBLE(HDPE) ❑99 OTHER ❑ 4. FIBERGLASS ❑ B. FLEXIBLE(HDPE) ❑99. OTHER ❑ 4. FIBERGLASS ❑ 5, STEEL Wt COATING ❑ 9. CATHODIC PROTECTION 464. ❑ 5. STEEL WI COATING ❑ 9 CATHODIC PROTECTION 095. UNKNOWN 465 V11.PIPING LEAK DETECTION(GhedrpiMatapoy) UNDERGROUND PIPING - PRESSURIZED PIPING(GaSINGLE WALL PIPING ABOVEGROUNp PIPI(Ch"*rN thef 466 a ) SINGLE WALL PIPING fik�rPRESSURIZED PIPING(CheaY that apply): 4b7 ck IE�i E, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND VISUAL ALARMS ❑ 2. MONTHLY 0-2 GPH TEST ❑ 2. MONTHLY 02 GPH TEST 1 ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 3. ANNUAL INTEGRITY TEST(0.1(3PH) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS(Check ad'that ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM r TRIENNIAL PIPING INTEGRITY ANY) 115. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) ❑ 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): :❑ 7, SELF MONITORING SAFE SUCTION SYSTEMS INO VALVES IN BELOW GROUND PIPING)- GRAVITY FLOW: ❑ 7. SELF MONITORING 9, BIENNIAL INTEGRITY TEST(fl.1 GPH] GRAVITY FLOW(Chock am that appy): ❑ B. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST(0.1 GPH) PRESSURIZED PIPING(Check all that pplyDAPJ): CONTAINED PIPING SECONDARILY CONTAINED PIPING )' PRESSURIZED PIPING(Chock am that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND(check 1 (Check ane) 12 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS w4) L3 t1. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS DISCONNECTION ❑ PUMP SHUT O 4- AUTO F C NO AUTO PUMP SHUT OFF F FOR LEAKS,SYSTEM FAILURE AND SYSTEM DISCONNECTION 3y�, ❑ . iJ 11. AUTOMATIC LINE LEAK DETECTOR(3-0 GPH TEST)WITH FLOW SHUT OFF OR ❑ C. NO AUTO PUMP SHUT OFF I RESTRICTION❑ ❑ 11. AUTOMATIC LEAK DETECTOR 12, ANNUAL INTEGRITY TEST(0.1 GPH} SUCTION/GRAVITY SYSTEM: ❑ 12. ANNUAL INTEGRITY TEST(0.1 GPH) 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS SUCTIOWGRAVITY SYSTEM: f ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY(Check ad That appy) ❑ 14- CCNTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF+AUDIBLE AND EMERGENCY GENERATORS ONLY(Check aff that apply) VISUAL ALARMS ❑ IC CONTINUOUS SUMP SENSOR W1TH,QUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL I` ❑ 15- AUTOMATIC LINE LEAK DETECTOR(3A GPH TEST)W rI HOUT FLOW SHLrr OFF OR ALARMS RESTRICTION ❑ 15. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) ppp ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) I❑ 17. DAILY VISUAL CHECK ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 17 DAILY VISUAL CHECK ( VIII.DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE f ❑ I. DAILY VISUAL CHECK DATE INSTALLED 468 2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 7 3. CONTINUOUS DISPENSER PAN SENSOR�Y Ili AUTO SHUT OFF FOR DISPENSER+AUDIBLE AND VISUAL ALARMS ❑ 6, NONECH LINER/MONITORING 469 i^ j I Cer1IPy Ihm ot the Infprallon provided herein !X.OWNEMPERATOR SIGNATURE -rs Iktre and akxwate to Iha IMI!d my krtOwledl2e. - - SIGkATURE OF OWN£RlOPERATOR I DarE _ 470 NAME OF OWNERlCPERATOR(pint) 471 TITLE OF OW ERIOP TOR t'or Owner 472 Permit Number(fa tical usa only} 473 101 n1 Appravad(Fpr bcal use only) 474 Pehwl Expinuon DoH(Far,tical usa only) 475 UPCF(1/99) i FDlmerty SWRCB Farm B