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Dashboard
Gas Station List
Gas Station Dashboard
Notification Multi Step Form
N. INDENTIFICATION OF UNDERGROUND STORAGE TANKS
Select FID
Select
123123
IDEM UST Registration Number
Part of a Compartmented UST
NO
YES
Number Of Compartments in UST
Compartment Identification Number
Date Installed
Date First Brought into use
(gallons) Estimated Total Capacity
Manifolded
Select
NO
YES
Manifolded to Compartment ID Number
O. STATUS OF UNDERGROUND STORAGE TANKS
Current Status
Select
TEMP CLOSED
IN USE
Status Date
P. SUBSTANCES CURRENTLY OR LAST STORED IN UNDERGROUND STORAGE TANKS
Petroleum
Select
GSL - Gasoline
DSL - Diesel
KER - Kerosene
E15 - Gasoline Blend
E85 - Gasoline Blend
E85 - Gasoline Blend
VGL - Virgin Oil
UOL - Used Oil
RCF - Leaded Racing Fuel
AVG - Leaded AV Gas
MXT - Mixture - List Substances
OTH - Specify
Maximum Ethanol %
Maximum Biofuel %
Other(specify)
Hazardous Substance
Chemical Abstract Service Number
Mixture of Substances
Product is compatible with tanks
Select
NO
YES
Q. UNDERGROUND STORAGE TANK CONSTRUCTION ATTRIBUTES
Manufacturer
Model
Material of Contruction
Select
Fiberglass
Steel
FRP Clad Steel
FRP Jacketed Steel
Other
Secondary Containment
Select
Not Applicable
Double-walled
Secondary Barrier
R. UNDERGROUND STORAGE TANK CORROSION PROTECTION
Corrosion Protection Type
Select
Not Applicable
Sacrificial Anodes (Galvanic)
Impressed Current
Anode Installation Date
Interior Lining
Select
NO
YES
linear Installation Date
Other (specify)
S. PIPING CONSTRUCTION AND PROTECTION
Manufacturer
Model
Date Installed
Material
Select
Fibreglass reinforced plastic
Flexible Composite
Rigid Fiberglass
Steel
Copper
None
Airport Hydrant Piping
Secondary Containment
Select
Double-walled
Secondary Barrier
Not Applicable
Corrosion Protection Type
Select
Not Applicable
Galvanic CP
Impressed Current
Dielectric Coating
Anode Installation Date
Product is compatible with piping
Select
NO
YES
Product Delivery Method
Select
Pressurized
European Suction
American Suction
Not Applicable
IDEM UST REGISTRATION NUMBER
Compartment Identification Number
T. UNDERGROUND STORAGE TANK RELEASE DETECTION
Primary UST Release Detection:
Select
ATG 0.2gph monthly
ATG CSLD
ATG CITLDS
ATG Interstitial Monitoring
Statistical Inventory Reconciliation
Manual Tank Gauging
Groundwater Monitoring
Vapor Monitoring
N/A
Manufacturer
Model
Secondary UST Release Detection
Select
ATG 0.2gph monthly
ATG CSLD
ATG CITLDS
ATG Interstitial Monitoring
Statistical Inventory Reconciliation
Manual Tank Gauging
Groundwater Monitoring
Vapor Monitoring
N/A
Manufacturer
Model
U. UNDERGROUND PIPING RELEASE DETECTION
Primary Piping Release Detection
Select
Annual Line Tightness Test
Interstitial Monitoring
ATG CITLDS
Statistical Inventory Reconciliation
0.2gph/0.1gph ELLD
N/A
Groundwater Monitoring
Vapor Monitoring
Manufacturer
Model
SECONDARY PIPING RELEASE DETECTION
(LEAK DETECTOR REQUIRED FOR PRESSURIZED PIPING)
Select
Annual Line Tightness Test
Interstitial Monitoring
ATG CITLDS
Statistical Inventory Reconciliation
3 Year Line Tightness Test
N/A
Groundwater Monitoring
Vapor Monitoring
ALLD w/Annual Test
PLLD w/Annual Test
ELLD w/Annual Test
Manufacturer
Model
Tertiary Piping Release Detection
Select
Annual Line Tightness Test
Interstitial Monitoring
ATG CITLDS
Statistical Inventory Reconciliation
3 Year Line Tightness Test
N/A
Groundwater Monitoring
Vapor Monitoring
ALLD w/Annual Test
PLLD w/Annual Test
ELLD w/Annual Test
Manufacturer
Model
V. SPILL AND OVERFILL PREVENTION EQUIPMENT
Catchment Basin / Spill
Select
Standard Spill Bucket
Doublewall Spill Bucket
N/A
Approved Alternative
Date Installed
Manufacturer
Model
Fill Latitude :
Fill Longitude :
Primary Overfill Prevention Equipment
Select
Auto Shutoff / Flapper
Overfill Alarm
Flow Restrictor / Ball Float
N/A
Date Installed
Manufacturer
Model
% Ullage Set Point
Secondary Overfill Prevention Equipment
Select
Auto Shutoff / Flapper
Overfill Alarm
Flow Restrictor / Ball Float
N/A
Date Installed
Manufacturer
Model
% Ullage Set Point
Under Dispenser Containment Present
Select
YES - Testable
YES - Not Testable
NO
Manufacturer
(mm/dd/yyyy) DATE INSTALLED
SUBMERSIBLE TURBINE SUMP PRESENT
Select
YES - Testable
YES - Not Testable
NO
Manufacturer
Date Installed
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