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FTFD PROr-RAM rnNr%0I DATRD F0 <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 2 <br /> Page Of <br /> VI.PIPING CONSTRUCTION(ekeck alloue.. l) <br /> '3 UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE ®I.PRESSURE 0 2.SUCTION ❑3.GRAVITY bsa. ❑1.PRESSURE 0 2.SUCTION [13.GRAVITY 459. <br /> CONSTRUCTION/ 0 1.SINGLE WALL [13.LINED TRENCH ❑99.OTHER 460. ❑1.SINGLE WALL 0 95.UNKNOWN 463, <br /> MANUFACTURER J92 DOUBLE WALL 0 95.UNKNOWN ❑2.DOUBLE WALL [199,OTHER <br /> MANUFACTURER <br /> bbt. MANUFACTURER 03. <br /> 0 1.BARE STEEL aj 6.FRP COMPATIBLE W/100%METHANOL 0 1.BARE STEEL [16.FRP COMPATIBLE W/100%METHANOL <br /> 0 2.STAINLESS STEEL 0 7.GALVANIZED STEEL [12.STAINLESS STEEL 0 7.GALVANIZED STEEL <br /> 0 3.PLASTIC COMPATIBLE WITH CONTENTS 0 95.UNKNOWN [13.PLASTIC COMPATIBLE W/CONTENTS 0 8.FLEXIBLE(HDPE) ❑99.OTHER <br /> 0 4.FIBERGLASS 0 S.FLEXIBLE(HDPE) [199.OTHER [14 FIBERGLASS 0 9.CATHODIC PROTECTION <br /> ❑ <br /> S.STEEL W/COATING 0 9 CATHODIC PROTECTION 464, 0 IN <br /> 5.STEEL W/COATG [195.UNKNOWN 465, <br /> J VD PTkINO EIECTION(check wwu A4ennptionrdianutam m ,wine w6mambm aelocal 9. <br /> M.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466. SINGLE WALL PIPING 467. <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP 0 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> SHUT-OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION <br /> +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. <br /> ❑2. MONTHLY 0.2 GPH TEST 02. MONTHLY 0.2 GPH TEST <br /> 03. ANNUAL INTEGRITY TEST(0.1 GPH) [13. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> [14. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> 0 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING 05, DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): [16. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> [17. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW [17. SELF MONITORING <br /> 0 9. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): <br /> 0 8, DAILY VISUAL MONITORING <br /> []9. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Check one) <br /> N a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> 0 b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM 0 b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> 0c. NO AUTO PUMP SHUT OFF Oc. NO AUTO PUMP SHUT OFF <br /> Pj11. AUTOMATIC LME LEAK DETECTOR(3.0 GPH TEST)_ffio FLOW SHUT 0 11 AUTOMATIC LEAK DETECTOR <br /> OFF OR RESTRICTION <br /> 19 12. ANNUAL INTEGRITY TEST(0.1 GPH) 0 12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTIONIGRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> 0 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS [113.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> [314, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 0 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> [115. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) wITHOUT FLOW [115.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST) <br /> SHUT OFF OR RESTRICTION <br /> [116. ANNUAL INTEGRITY TEST(0.1 GPH) 0 Ib. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> [117. DAILY VISUAL CHECK O 17. DAILY VISUAL CHECK <br /> VUL DISPENSER.CONTAINWNT <br /> DISPENSER CONTAINMENT 46a. O 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 04. DAILY VISUAL CHECK 469. <br /> DATE INSTALLED [12, CONTINUOUS DISPENSER PAN SENSOR,AUDIBLE AND VISUAL ALARMS [15. TRENCH/LENER MONITORING <br /> V3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 0 6. NONE <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> LY.OWNER/OPERATOR SIGNATURE <br /> Icertify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF OWNER/OPERATOR DATE: 470' <br /> NAME OF OWNER/OPERATOR(print): TITLE OF OWNER/OPERATOR: 4n, <br /> Permit Number(Agency use only) 473. Permit Approved By(Agency use only) 474. 1 Permit Expiration Date(Agency ane only) 475. <br /> UPCF hwfwrc-b(1/99)-3/4 http://www.u nidocs.org Rev.02/16/00 <br />