COMPLIANCE INFO_FILE 11 - Laserfiche WebLink

Home Browse Search

FOXOM") Rol FIED PROGRAM CONSOLIDATED FOR UNDERGROUND STORAGE TANKS - TANK PAGE 2 TANKS VI. PIPING CONSTRUCTION (Check aA that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ❑ 1 PRESSURE 12. SUCTION El 3. GRAVITY k,I' ❑ 1. PRESSURE 2. SUCTION 3. GRAVITY ❑ 1. SINGLE VIALL ❑ 3. LINED TRENCH C199. OTHER 5P 1. SINGLE WALL ❑ 95. UNKNOWN CONSTRUCTION/ MANUFACTURER 12 2. DOUBLE WALL ❑ 95. UNKNOWN ❑ 2. DOUBLE WALL _ " ❑ 99. OTHER MANUFACTURER Stockman (Steel Primary) MANUFACTURER Stnrkman ❑ 1. BARE STEEL ❑ B. FRP COMPATIBLE W/ 100% METHANOL ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE W/ 100% METHANOL MATERIALS AND ❑ 2. STAINLESS STEEL ® 7. GALVANIZED STEEL ❑ 2. STAINLESS STEEL 7. GALVANIZED STEEL ' CORROSION PROTECTION ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS [195. UNKNOWN ❑ 3. PLASTIC COMPATIBLE WITH CONTENTS ❑ 8. FLEXIBLE (HDPE) C3 99. OTHER 55 4. FIBERGLASS ❑ 8. FLEXIBLE (HDPE) [199. OTHER ❑ 4 FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ S. STEEL W' COATING ❑ 9. CATHODIC PROTECTION ❑ 5. STEEL W/ COATING ❑ 95. UNKNOWN VII. PIPING LEAK DETECTION (Check all that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING PRESSURIZED PIPING (Check all that apply): SINGLE WALL PIPING• PRESSURIZED PIPING (Check all that apply): - ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR ❑ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPM TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ALARMS ❑ 2. MONTHLY 0.2 GPM TEST ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ 3. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply): CONVENTIONAL SUCTION SYSTEMS: ❑ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ❑ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPM) ❑ 8. TRIENNIAL INTEGRITY TEST (0.1 GPM) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ❑ 7. SELF MONITORING 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all that apply): ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPM) ❑ 8. DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (O.1 GPM) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Cheek elf that apply): PRESSURIZED PIPING (Check all 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 one) (Check one) ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ❑ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ❑ C. NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF ❑ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) WITH FLOW SHUT OFF OR ❑ 11. AUTOMATIC LEAK DETECTOR RESTRICTION ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ 12. ANNUAL INTEGRITY TEST (0.1 GPM) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: 50 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS ❑ 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) 9 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) WITHOUT FLOW SHUT OFF OR ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) RESTRICTION ❑ 18. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ 18. ANNUAL INTEGRITY TEST (0.1 GPM) ❑ 17. DAILY VISUAL CHECK ❑ 17. DAILY VISUAL CHECK VIIL DISPENSER CONTAINMENT DISPENSER CONTAINMENT ❑ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4. DAILY VISUAL CHECK DATE INSTALLED ❑ 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS ❑ S. TRENCH LINER/ MONITORING ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS ❑ S. NONE IX. OWNER/OPERATOR SIGNATURE I certify that the information provided heroin's true and accurate to the best or my knowledge. SITE tM OPERATOR DATE NAME OF OWNERIOPERATOR (print) TITLE OF OWNERiOPERATOR C. Susi Jackson Permit Number (For local use only) Permit Approved (Forlocal use only) Permit Expiration Date (For local use only) CUPAFORM (4/99) Formerly SWRCB Form B