BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM �✓`�6 D 3 y� TANK UNDERAUND STORAGE TANKS - T K PAGE 2 VI. PIPING CONSTRUCTION(Check an that apply)a tl UNDERGROUND PIPING CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [15, TRENCH LINER MONITORING DATE INSTALLED [13. ABOVEGROUND PIPING 'r SYSTEM TYPE ® 1. PRESSURE ❑ 2. SUCTION 113. GRAVITY 458 ❑ 1. PRESSURE ❑ 2. SUCTION ❑ 3. GRAVITY 459 CONSTRUCTION I [11. SINGLE WALL ❑ 3. LINED TRENCH ❑ 99.OTHER 466 ❑ 1. SINGLE WALL [195. UNKNOWN 462 MANUFACTURER ® 2. DOUBLE WALL ❑ 95. UNKNOWN • 1 •��L^ ❑ 2. DOUBLE WALL [199, OTHER 463 MANUFACTURff-T'eiAen- U 461 MANUFACTURER 40 40 B ❑ 1. BARE STEEL 0 6. FRP COMPATIBLE w1100% METHANOL ❑ 1. BARE STEEL ❑ 6. FRP COMPATIBLE W1160%MEHIANOL ❑ 2. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ UKNOWN [12. STAINLESS STEEL ❑ 7. GALVANIZED STEEL ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS [199, OTHER [13. PLASTIC COMPATIBLE W/ CONTENTS ❑ 8, FLEXIBLE (HDPE) [199. OTHER ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE (HDPE) [14. FIBERGLASS [19. CATHODIC PROTECTION ❑ 5. STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464 ❑ 5. STEEL W/COATING 1-195, UNKNOWN 465 PIPING 466 PRESSURIZED PIPING (Check all thatapply): ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS. [12. MONTHLY 0.2 GPH TEST ❑3. ANNUAL INTEGRITY TEST(0.1GPH) CONVENTIONAL SUCTION SYSTEMS ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): [17. SELF MONITORING GRAVITY FLOW [19, BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMSAND (Check ane) ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [11b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ®C. NO AUTO PUMP SHUT OFF IkL~. AUTOMATIC UNE LEAK DETECTOR(3.0 GPH TEST) WITH FLOW SHUTOFF OR RESTRICTION ® 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM 013. CONTINUOUS SUMP SENSOR+ AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND VISUAL ALARMS [115. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION [I 16. ANNUAL INTEGRITY TEST (0.1 GPH) ❑17. DAILY VISUAL CHECK SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply). ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION+ AUDIBLE AND VISUAL ALARMS. ❑ 2. MONTHLY 0.2 GPH TEST 03. ANNUAL INTEGRITY TEST(O.IGPH) El 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) 05. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING GRAVITY FLOW (Check all thatapply): 08. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSORWITH AUDIBLE ANDVISUAL ALARMS AND (Check one) ❑ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [3c NOAUTO PUMP SHUT OFF [111, AUTOMATIC LEAK DETECTOR 012. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTIONIGRAVITY SYSTEM ❑ 13. CONTINUOUS SUMP SENSOR -AUDIBLE ANDVISUALALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND VISUALALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ❑ 16. ANNUAL INTEGRITY TEST (0.1 GPH) 017. DAILY VISUAL CHECK DISPENSER ® 1, FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK CONTAINMENT 468 [32. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS [15, TRENCH LINER MONITORING DATE INSTALLED [13. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER a [16. NONE 469 12/98AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE I certify that r ation pro d her is t and accurate to the best of my knowledge. 470 SIGNA W E TO DATE 4/8/03 NAME OF (print) TITLE OF OWNER/OPERATOR 472 O erationS 8, Environmental S ecialist Smith Dennis Smith 473 Permit Approved (For local use only) Permit Expiretion Date (For local use only) Permit Number (For local use only) 475 40 40 B Formerly SWRCB Form UPCF (1/99 revised)