Laserfiche WebLink
UNMED PROD R" CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br />page Of <br />TIPINGIC <br />LTNI)ERUROUND PIPING AT30VCGROUND PIPING <br />SYSTEM TYPE 9-1, PRESSURE 0 2. SUCT70W 0 3. GRAVITY 459. 0 1, PRESSURE 02 -SUCTION 01GRAVITY 459, <br />(-VNMUCT'OW 11 L SINGLE WALL IJ 3. LINFI) TRENCH 0 99, OTHER 46a OLSINGLEWALL <br />MANUFACTURER Ej 95. UNKNOWN 462, <br />J62. DOUBI,E WALL IJ 95. UNKNOWN [12. DOV111.13 WALL 0 99. OTHER <br />MANUFACTURER - 461 1 MANUFACTURER 463. <br />[31.13ARESTEEL 0 6. FRI* COMPATIBLE wA 60% ME THANOL 0 1. BARES Th-vL 0 6. MCOMPATIBLE W/100% Mrrfimm <br />02.S:rAjNLF=STEEL, 0 7. GALVANi-n STEEL 0 2.STATNI.ESS STEEL 0 7. GALVANIZED STEEL <br />L1 3. PLASTICCOWAIMLE WITH comamS 0 95. UNKNOWN [13. PLASTIC COMPATIBLE <br />,W/CONTF <br />04. Flasml.ABS NTS MS. FLEXIBLE (FIT)pE) 0 99. OTHER <br />0 & FLEXIBLE (IIDPR) 0 99.OTHER 04.FIBERGLASS M 9. CATHODIC PROTECTION <br />❑ 5. STEEL W/00ATING. 113 9, CATHODIC PROTECTION 464.. 1 0 5. ST1, W/COATING 0 95. UNKNOWN <br />465, <br />SINGLE WALL PIPING UNDERGROUND PIPING 4". SINGLE WALL PIPING ABOVEGROUND PIPING 467 <br />PRESSURIZAD PIPING (ChaCk an && apply), PRESSURIZED PIPING (Vher-k all dw applyT <br />ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP 0 I. ELECTRONIC LINE LEAK DETriC.TOR 3.0 GPH Tr -ST -Wffjl AUTO Pump <br />S' 'UT -OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM D12 -CONNECTION SHUT OFF FOR LEAX, SYSTEM FAILURE, AND SYS*rEM DISCONNECTION <br />+ AUDIBLE AND VISUAL ALARMS, + AUDIIII.F. AND VISUAL ALARMS. <br />0 2. MONTHLY 0.2 QM TEST [32. MON`l1iLY 0,2 GPH THST <br />Q3. ANNUAL INTEGRITY TEST (0.1 GPI1) 03. ANNUAL 11v7EGRITY 'I'EST (0.1 G1,H) <br />C) 4. DAILY VISUAL CHECK <br />CONVENTIONAL SUCTION SVMMS CONVENTIONAL SUCTION SYSTEMS (Cho* all that apply) <br />0 5. DAILY VISUAL MoNrMkiNG OF PUMPING, SYSTEM + TRIENNIAL PIPING <br />[] <br />INMGPxry TEST (0,1 Gm I. DAILY VISUAL, MONITORING or PIPING AND PUMPING SYSTEM <br />SAFZ SUCTION SYSTEMS (NO VALVES IN BELOW GROUND 1`11INGY, E3& TRIENNIAL iNTEoRrryi-Ei'T(o.iGPH) <br />[17. SELF MONITORING SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): <br />GRAVITY FLOW 0 7. sm.FmonvoRiNG <br />09. BIENNIAL INTEGRITY TEST (0.1 GPI I) GRAVITY FLOW ((Im& an that apply): <br />0 & DAILY VISUAL MONITORING <br />09. BIENMALiNTEGRITyTEST (OAGPH) <br />SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br />PRESSURIZED PIPING (C at all dm applyk PRESSURIVED PIPING (O=lc a that applyy <br />10. CONTINUOUS TURBINE SUMP SENSOR wrm AUDIBLE AND 'VISUAL IQ.' CONTINUOUS TURBINE SUMP SENSOR WMI AUDIBLE AND VISUAL <br />ALARMS ANA (Cboekom) ALARMS AND (CfwA orte) <br />E3 & AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0 a. AUTO PUNT SHUT OFF WHEN A LEAK OCCURS <br />1021%, AUTO PUMP SHUT OFF FOR LEAKS, S YSTEM FAILURE AND SYSTEM Z3 b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYS'rhm <br />DISCONNECTION DFSCONNEC'nON <br />.A <br />Mr -NO AUTO PUMP SHUT OFF 0. -NO AU'I'OPtJMPSWN0FF <br />',0Q 17. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) VAT14 FLOW SHUT <br />OFF OR RF-%-MCnON ®I I. AUTOMATIC LEAK DETEc-rop, <br />[3 12, ANNUAL INTEGRITY TEST (0.1 GPH) 0 12. ANNUAL INTEGRITY TEST (0.1 GPI) <br />svcnON/GRAVrffSYSnM SUCTION/GRAVITY SYSTEM <br />0 1.3. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS 0 13, CONTINUOUS SLOW SENSOR + AUDIBLE AND VISUAL ALARJ& <br />EMERGENCY GENERATORS ONIX <Cbo& all gut apply) EMERGENCY GENERATORS ONLY (LIuKk all that apply) <br />0 14. (7ONTINUOU5 SUMP SENSOR WIr <br />JOUT AUTO PUMP $1 IUT OFF [j 14. CONTINUOUS SUMP SENSOR WITT IOUT AUTO PUMP SHUT OFF <br />AUVIBLF AND VISUAL ALARMS AkIDIBLE AND VISUAL ALARMS <br />0 15. <br />AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) Yfl_MOUT FLOW <br />SHUT OFF OR RhSTIUCnON 1115. AUTOMATIC LINE LEAK mmcrott (3.o GPj I TFsT) <br />0 16. ANNUAL FNTEGRM TEST (0. 1 Gp1j) 0 16. ANNUAL INTEGRII-Y TEST (o. I GPH) <br />Q 17. DAILY VISUAL CHEM- 0 17. DAILY VISUAL CHECK <br />Vft. CQ'NT-.AWMjM* <br />DISPENSER CON rAINMENT 468. <br />1. FLOAT MECI IANISM THAT SHUTS OFF SHEAR VALVE 0 4. DAILY VISUAL CHECK 469, <br />DXI'h INSTAIJ,.ED OZ CONTINUOUS DISPENSER PAUNSENSOR 4 AUDIBLE AND VISUAL ALARMS E3 5, TRENCRUNER MONITORING <br />L3 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR <br />DISPI24SER -t AUDILE, AND VISUAL ALARMS Q 6. NONE <br />I certify that the information praviiu is true and a=uvjDm to the bLqt of my knowledge. <br />SIGNATURE OF DATE: 470. <br />TITLE OF 0WNF"PE9XI*OR: 4?2 <br />NAME OF OWNER/OP19LATOR (Prin* <br />PmutNumbur (Agenoy use only) 473. 1 Pernlit Apps-od By (A* --y uroe =if) m=_7 Expiration Date (Agmcy use *Wy) 475. <br />IJK-T hwhvre-b 3/4 www-vnidomorg Rev- 02J16M0 <br />8T0/ OTOICI 000z# 60:tO 90OZ/TZ/80 <br />