|
t s UNIFIED PROGRAM CONSOLIDATED FORM
<br /> TANK
<br /> UNDERGROUND STORAGE TANKS -- TANK PAGE 2
<br /> Aage -of
<br /> t T heck all that apply) - f
<br /> VI.PIPING CONSTRUCTION
<br /> UNDERGROUND PIPING ABOVEGROUND PIPING
<br /> 5 STEM YPL ❑ ru SSURE []2 SIJCTI(DN ❑ UAVT ti? j Q 1 PR . ❑ SUCTION ❑3.GRAVITY 459
<br /> + ------ -- ._.._.___.__� --�_
<br /> ..y
<br /> UO".STR 'v ❑ SWGi F'W LL ❑3 '.INE„"RENT Ft [ i- L"k fC ❑1 SINGLE WA-, CJ Ab.UNKNOWN 462
<br /> MANUFAC`URER Z 2 "DOUBLE WALL ❑35.UNKNOWN ❑2 DOUBLE WALT. ❑95 OTHER I
<br /> MANUFACTURER -� 461 ' MANUFACT;;RER 463
<br /> ❑1.BARE STT FRP COMPATIBLE w1*1% tilt HANC,. ]1 BARE STEEL ❑6 FRP COMPATIBLE W1100%METHANOL
<br /> ❑2.STA NLES_ '.-EF ❑7 GA_•/aNIZ.0 STEEL []UhNfr✓VN Ll 2 STAINLESS ST=F.. C3' GALVANIZED STEEL.
<br /> 'LAS"C JF' '".ELc ti CONTENTS ❑')",t. FLiF,R ]3. P�4S"!C COMPATIBLE WlCCNTENIS ❑8 FLEXIBLE(HOPE) ❑99. OTHER
<br /> i
<br /> 9 FLEXIBI.E;HDPE' ]4 PaERGLASS D 9 CATHCDIC PROTECT ON
<br /> ❑5 STEE r []9 CA--ICDIC PRUTECTICN 464 ]5 STEEL'N Cr ATI`sG ❑95UNKNOWN 466
<br /> VII.PIPING LEAK DETECTION'check all ha'at Fly)(A descnpron of the mon_itonng program shall be�ubrm:ted to he'ora(ageocy.;
<br /> --- -_-_ -
<br /> UNDERGROUND PIPING ABOVEGROUND PIPING
<br /> SINGLE WALL PIPING Ir,,, _ SINGLE WALL PIPING 4E7
<br /> PRESSJRIZED 01=INGtChec! Al rnzappl,) ?RESSURIZED PIPING t Neckar Watapply)
<br /> ( E JE _AK "j 3 P T '1Tr Ii "Jt Cr Wp- [DL EEGTRGV� UJEILAFOETEGTvR30a TE ��Th'Al1TrjPUrAPSHUT'OFFFQR
<br /> ICIdAUO,'RLL N_ I::'IA LEAK.a'!ST "A AII.JRf ANDSYS EV JNE.,TOr'-AIJO LEANDVISUAL
<br /> A+_liRP.4 ALARMS. t
<br /> ❑2 VCN P`-1;.<:; "EST ❑2. M°;PTHL Y O.2 GPH FST
<br /> ,
<br /> 03 A_NNJ+=1_-fJiEGRIfYTESTr?,1G°N) 173. ANNJALINTE( RIT,7E.ST110.1CPH)
<br /> ❑4 DAILY VISUAL"HE,K f�
<br /> GGN'JEr1T ON,l J .r)ti YS EG1S 0N'VEN7 0NAL SUC ON SYS LMS(Check all.hat at`ply) I
<br /> ❑5 D41LY , "v.,II OR' "-�OF PI,MFi'v(`,S'/STEMTRiENMA'-°III'NG nN`EGk!TY i
<br /> S D
<br /> TEST�V t S7`;- D DN,Y'JIS(,AL MG.JI'7RINC,Of�IP,VGpND p,;LI �NI>SYSTEM
<br /> SAFE S.JCTIOf,-, ,'S,NC.VALUES N BELOW GROUNDRIDING) O 5. TRIENNIAL INTFGR;-" TI-ST rp 1
<br /> 07 SELF 'NC SAF-;%CTIONSYST=MS,N^VALVES IN BELGOVJ5POtINDPIPN(J )
<br /> GRAV;TY=I-GVV E37. SELF rdONl CRIW
<br /> i t
<br /> h Q 5 RIENN'A;.!hi=:'RIT`r TEST ICC D GE'K ,;vAVT1 PLO C, v,lv!`at iro:y;.
<br /> i
<br /> 08 DAII` VISJr L•.!JPI.-!'P,lrJG
<br /> ,
<br /> j SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING
<br /> ! PRESSUP,ZE PIPING Ct,eck a i;-a:-apr y. PRESSUR;ZED F NC
<br /> 10. .R?,`1-:1-40PSE' ? `HµUDi9LE AND, ,I,_ t
<br /> _. C tiL. T, .:'NE aF,J I '�. _ ,i,.ALF A,[ ll,;.1H:_A ARMS AND
<br /> fvhEGA u"aI
<br /> 2.
<br /> I f ., r •LE:,r. ,-F JR7 ' ❑�. !-.I_�l -'�1�5.�.�T 0., 'vrHEN a,
<br /> is ❑h7.t =. E„ 'i d:Fd Lt,r. ❑ 1.i' F_.7 fF K'R Ah A r'ivt ria.JR_,qND SYSTEM
<br /> l J Q Il, f _,w' f r
<br /> Q 0 F.,,TI Al TH `1)1', -
<br /> ,� i,F. I
<br />{ PE TP '.I - - (��•_ AI TO A :i' r _'t-a ;'r.
<br /> t'
<br /> 1;. A JrJt,al-NT l,R, ;..TES (c
<br /> I" SUCTIONA�-",A�I� v S'r' TEM �',ICT1C:NtGR4tlli' "STEM
<br /> 013 N� N,_I`��_ 5�,Ar OR U='�3LEAiJDVISU'Ai_ALARMz: � Q'3 GCNTItiUOLU JMP$FNS(iRrAL1DIBLE ANDV5UV AUA.RiVS
<br /> - EMERGENCY GENERATORS ONLY(Check ai,:f al a.LI ) EMERGENCY GENERATORS ONLY .he r WI that appty)
<br /> [)14. CON %!-' -SI;MP SENSOR;"ri"_qi_ ?AUTO THUMP ShUT JFI- -Ai U,EI.= ;,NO ' ❑'4. ;-cN1'NJOUS SJMr Sc rt1SOR W;71iylI T r AUTO JNIP SHUT CFc-AUDIBLE AND
<br /> 4L •R.1- .. 'V'SUAL ALARMS,
<br /> p
<br /> ❑15 Ai T)+ BEAK DE-E;T(it:13.0 GPH TEST)!JVITT FtONH., i i G OR
<br /> RG TP ;1 -`H-GU' ❑15. AUTOMATIC LiNF "AK OETEC-OR(3.0 GPH TEST)
<br /> ❑16. .A�I I,..,,_ rJT.-.41 Y FF37 f0 ;''y1
<br /> ❑16. ANNUAL INTE;_PI
<br /> 17 DAILY ViSUA.I iEi;^:
<br /> ------V1-1I DISPENSER CONTAINMENT
<br /> DISPENSER ---.
<br /> CONTAINMENT -'1.�ATh1FC1iANISM THAT ,'aL.i._,)F-SHF;3R VALVE []4 GA,. SJH.( iEC'K
<br /> DATE INSTALLED a58 ❑2 CONTINUOUS DISPENSER'AN SLN,)CR AUDIBLE AND VISI-W.ALARM!.,
<br /> ©S TRENCH LINED MONITORING®3. CCNTINUODSE�ISP N.FPPAfJSFNSJP.±NI;�lAIJTOSHUTOFF>'pRGISP6'JSE;2. �
<br /> AUDIBLE AND VISUAI AILA MS0 6.`IONS 469
<br /> - v IX.OWNERIOPERATOR'SIGNATURE
<br /> I Cp4tif ihaT r.F - - YP�4-� -L je ar.0 arcarate to B n
<br /> y �VIP.7Qt=
<br /> SER';TGR
<br /> ".rector of E)vneering
<br /> I'
<br />
|