The URL can be used to link to this page

Home My WebLink AboutUST PLAN CHECK 3.5.19UST PLAN CHECK 3/15/2018 PLAN CHECK TYPE UST Installation FACILITY NAME �;�'�L l S U �',t .4 U c .5�� FACILITY ADDRESS PERMIT NUMBER HTE NUMBER SCOPE OF WORK, SUMMARY Page No. GENERAL APPLICATION CERTIFICATION Service Request Updated Correct Fee Paid Contractor Information Complete on Application Contractor Signed Application Owner Information Complete Equipment List Completed Scope of Work Completed Application signed by Owner or Owner Signature Authority Form submitted Three sets of Plans submitted All subcontractors identified CSLB License is appropriate S-698-171 Exp: C61 -D40 is valid only for calibration work if issued after January 18, 2001 CSLB License Number: Hazardous Substance Removal Certification (required for installation and removal) Exp: Active Worker's Compensation Exp: j 2 65 r� The following MUST be conducted by a Qualified Installer: Installation of an underground storage tank and /or connected piping and completion of all work on the tank /piping manufacturer's installation checklist. Qualified Installers must possess or work under the direct and personal supervision of an individual physically present at the work site who possesses all of the following: A valid, current contractor's license issued by the Contractor's State License Board, a valid, current certificate of training from the manufacturer(s) of the component(s) being installed and a valid and current ICC UST Installation /Retrofitting certificate. ICC UST Installer / Retrofitter Certification Submitted Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: UST Plan Check Page 1 of 10 UST PLAN CHECK The following MUST be conducted by a Qualified Service Technician : All work related to UST leak detection monitoring equipment, (installation, repair, replacement, maintenance and calibration), Annual Monitoring Certification, Secondary Containment Testing (including initial testing of newly installed secondary containment systems). Qualified Service Technicians must possess or work under the direct and personal supervision of an individual physically present at the work site who possesses all of the following: CSLB license as defined by 23 CCR 2715 (i)(1) or a Tank Tester's license issued to the individual by SWRCB, valid UST ICC Service Technician certificate, valid and current certificate of training from the manufacturer(s) of the component(s) being tested, repaired, or serviced. In the event that no training or certification exists, the local agency may approve comparable alternate training or certification. ICC Service Technician Certification Submitted Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Contractor License is appropriate Exp: C61 -D40 is valid only for calibration work if issued after January 18, 2001 CSLB License Number: Monitoring Equipment Manufacturer Certification Submitted Manufacturer: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Tank Manufacturer Training Certification Submitted Manufacturer: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Pipe Manufacturer Training Certification Submitted Manufacturer: Exp: Name: Exp: Name: UST Plan Check Page 2 of 10 UST PLAN CHECK 3/15/2018 PLAN CHECK TYPE UST Installation FACILITY NAME Manufacturer: Under Dispenser Containment Manufacturer Training Certification Submitted Manufacturer: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Containment Sump Manufacturer Training Certification Submitted Manufacturer: Exp: Name: Exp: Name: Exp: Name: Exp: Name: - Exp: Name: Transition Sump (vent, etc.) Manufacturer Training Certification Submitted Manufacturer: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Spill Containment Manufacturer Training Certification Submitted Manufacturer: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Exp: Name: Other UST Component Manufacturer Training Certification Submitted Manufacturer: Exp: Name: Exp: Name: Manufacturer: Exp: Name: Exp: Name: UST Plan Check Page 3 of 10 UST PLAN CHECK 3/15/2018 PLAN CHECK TYPE UST Installation; FACILITY NAME S L S Q2U s �✓�- Name(s) of Qualified Individual(s) with all required certifications: UST Plan Check Page 4 of 10 North arrow Scale of drawing Building(s), neighboring buildings, streets V111 and property lines- -where applicable Dispenser island(s) Guard posts /bollards Tank Size Tank Size Tank Size #1 #3 #5 #2 #4 #5 Indicate Slope on Piping Toward Tank (inches per foot and direction) �- Location of Monitoring Panel Location of Overfill Alarm Location of Emergency Shut Off(s) Location of any Proposed or Existing AZ (observation, monitor, etc.) PARTS LIST Status Notes /Comments UST Plan Check Page 4 of 10 UST PLAN CHECK UST Plan Check Page 5 of 10 3/15/2018 PLAN CHECK TYPE UST Installation FACILITY NAME L.I-YS gt) 15 7-A Parts list to be included on the drawings (must include make and model number and correspond to side view and /or end view drawings by number or letter). PIPING Status Notes /Comments Location of Product Piping and fTermination of Pipe Location of Vapor Recovery Piping and Termination of Pipe Location of Vent Piping and Termination of Pipe f Location of Chase Piping Vent Termination (must be 5 feet from any building or buildable property line) Method(s) and location(s) of monitoring f for piping Type of piping labeled (i.e.: rigid FRP, Enviroflex, etc.) Piping trench show the distances between pipes to bottom, sides and surface of trench. Backfill material and type /thickness of cap over trench Crossover Detail End View of Piping f Piping is UL listed Piping monitoring application is approved Monitoring Equipment approved for application Page No. SIDE /TOP VIEW OF TANK AND EXCAVATION Status Notes /Comments Tank Manufacturer identified Size of tank(s) in gallons on plans Dimensions of excavation and tank(s) UST Plan Check Page 5 of 10 UST PLAN CHECK 3/15/2018 PLAN CHECK TYPE UST Installation FACILITY NAME �' Method of attachment of sump to tank UST Plan Check - Page 6 of 10 Distance from ends and sides of tank(s) to r sidewalls of excavation Depth of backfill beneath tanks and type of backfill material �►,. Type and thickness of cap above tank(s) Location of sumps and /or bungs Location of spill containment and lids Risers ATG(s) (tank level probe) Turbine(s) Compartments in Tank Drop Tube Overfill prevention device(s) Any slab or deadman with location and type of the tie down straps Level or slope of tank Hold down calculations for UST if water present in area (calculations can be listed on a Aj 4t separate letter) ,S Adapters Sump lids and clamps (or other method of securing to lid) Sealant between sump and manway skirt (if used) Fill riser caps VR Phase I riser caps Location of Interstitial sensor, reservoir, riser, riser cap and, where applicable, at grade access box V/- Tank(s) is /are UL listed Monitoring Equipment approved for application SIDE /TOP VIEW OF SUMPS Notes /Comments Status �' Method of attachment of sump to tank UST Plan Check - Page 6 of 10 PLAN CHECK TYPE UST PLAN CHECK 3/15/2018 UST Installation FACILITY NAME 5u L—t-ys gc1c VA- ✓ r S -r-4- UST Plan Check Page 7 of 10 UST PLAN CHECK 3/15/2018 PLAN CHECK TYPE UST Installation FACILITY NAME V/ Sump Lid Spill Containment Spill Containment meets requirements Sump Top Hat Interface between the manway skirt and sump top hat Interface or connection between spill buckets SIDE /TOP VIEW OF UNDER DISPENSER CONTAINMENT (UDC) Status Notes /Comments f Type of UDC (FRP, Shallow, Deep, etc) Termination of UDC secondary wall (if a double wall UDC) Penetration into UDC (depict type of penetration fitting) All piping and conduits as they go through penetrations Termination of secondary walls of pipe V/-- inside the UDC Attachment of pipes, etc. to UDC infrastructure Location of UDC liquid sensor V/0^ Location of UDC interstitial sensor Hydrostatic Double Wall Monitoring: Type of liquid in interstice and directions f for labeling Communication testing apparatus location and type identified (ball valve, manometer, etc.) Flex connectors Shear valves Adequate labeling of components in plans UDC is UL listed Monitoring sensors are approved for application UST Plan Check Page 8 of 10 UST PLAN CHECK 3/15/2018 PLAN CHECK TYPE UST Installation FACILITY NAME 541 1,.L.VS 8U Eal V-, 5 -r'-f- SIDE /TOP VIEW OF PIPf TRANSITIONS AND PENETRATIONS Notes /Comments Status Penetrations of underground piping into basement or to ground surface -- include the pipe or collar that provides a conduit for the double wall pipe. SIDE /TOP VIEW O'F VENT RISER /SUMP Notes /Comments Status Tank vent termination is a minimum of 12 feet above grade Depict the flex connectors and secondary boots Location of Vent Sump annular sensor �! Location of Vent Sump liquid sensor Hydrostatic Double Wall Monitoring: Type of liquid in interstice and directions for labeling Communication testing apparatus location and type identified (ball valve, manometer, etc.) Transition from flexible or fiberglass piping to above ground piping - include protection from sunlight and elements, as well as construction of aboveground piping. Vent Sump UL listed Monitoring sensors are approved for application SIDE VIEW OF GUARD iPOS TS/BOLLARDS Status Notes /Comments Bollards or guard posts to include: construction, diameter, height, distance between posts, distance from dispensers, depth and diameter of footing. VPH LAYOUT Status UST Plan Check Notes /Comments Page 9of10 UST PLAN CHECK 3/15/2018 PLAN CHECK TYPE UST Installbtion'rz FACILITY NAME 5LJ -j-L L/S 0 0C,t/+ V1 s r -4� New installations: Drawing and /or table of proposed monitored zones (vacuum, pressure, hydrostatic). Include vacuum i,/' volume for each vacuum monitored zone. UST REMOVAL Status Notes /Comments ,A y Removal Application UST Plan Check Page 10 of 10