2012-05-17_PERMIT FILE - C1981012 ‎(2)‎

• Permit No: C1981012
• IBM Index Class Name: Permit File
• Doc Date: 5/17/2012
• Section_Exhibit Name: EXHIBIT 27 SPILL PREVENTION CONTROL AND COUNTERMEASURE PLAN
• Media Type: D
• Archive: No

CO Dept of Labor & Employment - Division of Oil & Public Safety
63317 1h Street, Suite 500, Denver CO 80202 -3660
Phone 303 - 318 - 853318507 - Fax 303 - 318 -8488 - E -mail oil.Dublicsafety(d)state.co.us - Web hftp: / /ops.cdle.state.co.us/
ABOVEGROUND STORAGE TANK SYSTEM INSTALLATION AND UPGRADE APPLICATION
Facility Name:
Tank Material (Construction) Codes
UL 142: UL 142/Equivalent
UL 2080: UL 2080 Fire Rated/Equivalent
UL 2085: UL 2085 Protected
Tank /Piping Wall Type Codes
S: Single Wall D: Double Wall
Overfill Prevention Method Codes
BF: Ball Float Valve FV: Fill Tube Valve
AL: External AudibleNisible Alarm
Tank Corrosion Protection Codes
IC: Impressed Current Sys. GV: Galvanic Anodes
NEC: No Electrolyte Contact
NONE: None — Other Testing Required
Emergency Relief Venting Codes
ERV: Emergency Relief Venting Device
WRS: Weak Roof-To-Shell Seam Construction
OTHER: Other Method (manway w/ long bolts, etc)
NA: Not Required (ie Class IIIB > 12,000 gals)
Tank Interstitial Monitoring Method Codes
ES: Electronic Sensor MV: Manual/Visual Insp
NA: Not Applicable
Piping Type
AG: Aboveground UG: Underground NA: None
Piping System Codes
PR: Pressurized
SU: Suction SS: Safe Suction
GRAV: Gravity Feed NONE: No Delivery Piping
MAN: Manifolded Tank — No Delivery Piping
Piping Material Codes
FRP: Fiberglass Reinforced Plastic
FLEX: Flexible Plastic Piping
STEEL COPPER
Line Leak Detector (ALLD) Type Codes
E: Electronic M: Mechanical
NA: Not Required - (Manifolded/Gravity, etc.)
Piping Connector Type Codes
SW. Swing Joint FL: Flex Connector
FPP: Flexible Plastic Pipe Adaptor
Piping Corrosion Protection Codes
FRP: Fiberglass Reinforced Plastic (Piping)
FLEX: Flexible Plastic Piping
AG: Aboveground Piping
IC: Impressed Current System (Piping/Connectors)
GV: Galvanic Anodes (Piping/Connectors)
NC: No Electrolyte Contact (Connectors)
BY Plastic Boot (Connectors)
Piping Release Detection Method Codes
L1: ATG .2 /.l gph Monthly Monitoring
L2: Double -wall & Sumps w/ Sensor
L3: Double -wall & Sumps w /out Sensor
L4: SIR (Statistical Inventory Reconciliation)
L5: Annual Line Tightness Testing
L6: Other Approved Method (i.e. Tracer Testing)
L7: Not Required (SS /GRAV) L8: 3yr LTT
LI1: Monthly Visual Inspection
Owner Name:
Address:
Mailing Address:
City:
Tank Material (Construction)
State: CO
Zip:
City:
State:
Zip:
Contact
Name:
Phone #.
Contact
Name:
Phone #:
Description Of Work:
Type Of Facility: Gas Station [ ]
Bulk Plant [ ] Commercial/Industrial [ ] Airport [ ] Government [ ] Other [ ]
A plot plan must accompany this application that includes the name and address of facility, lot dimensions, and distances from tanks to nearest
important building, roads, railroads, property lines, dikes or impoundment areas, existing tanks, and dispensers.
TANK INFORMATION
Tank Material (Construction) Codes
UL 142: UL 142/Equivalent
UL 2080: UL 2080 Fire Rated/Equivalent
UL 2085: UL 2085 Protected
Tank /Piping Wall Type Codes
S: Single Wall D: Double Wall
Overfill Prevention Method Codes
BF: Ball Float Valve FV: Fill Tube Valve
AL: External AudibleNisible Alarm
Tank Corrosion Protection Codes
IC: Impressed Current Sys. GV: Galvanic Anodes
NEC: No Electrolyte Contact
NONE: None — Other Testing Required
Emergency Relief Venting Codes
ERV: Emergency Relief Venting Device
WRS: Weak Roof-To-Shell Seam Construction
OTHER: Other Method (manway w/ long bolts, etc)
NA: Not Required (ie Class IIIB > 12,000 gals)
Tank Interstitial Monitoring Method Codes
ES: Electronic Sensor MV: Manual/Visual Insp
NA: Not Applicable
Piping Type
AG: Aboveground UG: Underground NA: None
Piping System Codes
PR: Pressurized
SU: Suction SS: Safe Suction
GRAV: Gravity Feed NONE: No Delivery Piping
MAN: Manifolded Tank — No Delivery Piping
Piping Material Codes
FRP: Fiberglass Reinforced Plastic
FLEX: Flexible Plastic Piping
STEEL COPPER
Line Leak Detector (ALLD) Type Codes
E: Electronic M: Mechanical
NA: Not Required - (Manifolded/Gravity, etc.)
Piping Connector Type Codes
SW. Swing Joint FL: Flex Connector
FPP: Flexible Plastic Pipe Adaptor
Piping Corrosion Protection Codes
FRP: Fiberglass Reinforced Plastic (Piping)
FLEX: Flexible Plastic Piping
AG: Aboveground Piping
IC: Impressed Current System (Piping/Connectors)
GV: Galvanic Anodes (Piping/Connectors)
NC: No Electrolyte Contact (Connectors)
BY Plastic Boot (Connectors)
Piping Release Detection Method Codes
L1: ATG .2 /.l gph Monthly Monitoring
L2: Double -wall & Sumps w/ Sensor
L3: Double -wall & Sumps w /out Sensor
L4: SIR (Statistical Inventory Reconciliation)
L5: Annual Line Tightness Testing
L6: Other Approved Method (i.e. Tracer Testing)
L7: Not Required (SS /GRAV) L8: 3yr LTT
LI1: Monthly Visual Inspection
New / Used / Existing Tank
Tank Material (Construction)
Tank Wall Type
Total Capacity (gals)
Compartmentalized Tank (Y/N)
Compartment Sizes
Product (by compartment if app)
Tank Manufacturer
Tank Model (Envirovault, etc.)
Manifolded Tank (Y/N)
Spill Containment Manufacturer
Spill Containment Size (in gals)
Overfill Prevention Method
Overfill Prevention Manufacturer
Tank Foundation (concrete, etc)
Electrolyte Contact (Y/N)
Tank Corrosion Protection
Emergency Relief Vent (ERV)
ERV Size (in inches)
Interstitial Monitor (Dbl -Wall)
Interstitial Monitor Manufacturer
Vapor Recovery Regd (Y/N)
Vapor Recovery System Piping: Line Size: [ " ] Connection Size [ " l
PIPING INFORMATION
Piping Type
Piping System
Piping Material
Piping Wall Type
UG Piping Manufacturer
Model (Pisces, Red Thread, etc.)
ALLD Type (UG piping)
UG Piping Connector -Tank
UG Piping Connector -Disp
Piping Corrosion Protection
Connector -Tank Corr. Protection
Connector -Disp Corr. Protection
Piping Release Detection Mthd.
ADDITIONAL INFORMATION
Installed In A Vault (Y /N)
E- Generator Base Tank (Y/N)
Connected To Dispenser (YIN)
Tank -To- Building Distance
Tank -To- Property Line Distance
Tank -To- Dispenser Distance
Describe Diking/Impounding
Fire Protection District: Yes [ ] No[ ] District Name [ ]
BURIED PIPING INSTALLATION INFORMATION
Backfill Material (squeege, crushed rock, sand, etc.): Type: [ ] Depth: [ " ]
Cover (concrete, asphalt, backfill only, etc.): Type: [ ] Thickness: [ " ]
INSTALLER INFORMATION
Installer name (company):
Installer address:
Installer City/State /Zip: Phone #:
This application is approved when signed below, and is valid only for a period of six (6) months unless an extension is granted by the division in writing. All requests for
extension must be made in writing. An approval is contingent upon construction being in full compliance with the requirements of Colorado laws and regulations, and
the National Fire Protection Association, including NFPA 30 and NFPA 30A, and upon the installation being carried out in accordance with the approved plan of
installation. Tanks must be registered within 30 days of the date they are filled. An inspection of this installation must be made by the division before placing in service.
Date Reviewed / / Approved By FOFL / OUP
10/04
MR 115 Page 27 -55 Rev. May 2012