Form UST-19 "Certification of Leak Detection Exemption for Suction Piping Associated With Underground Storage Tanks" - North Carolina

What Is Form UST-19?

This is a legal form that was released by the North Carolina Department of Environmental Quality - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2018;
  • The latest edition provided by the North Carolina Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form UST-19 by clicking the link below or browse more documents and templates provided by the North Carolina Department of Environmental Quality.

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Download Form UST-19 "Certification of Leak Detection Exemption for Suction Piping Associated With Underground Storage Tanks" - North Carolina

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CERTIFICATION OF LEAK DETECTION EXEMPTION
UST-19
FOR SUCTION PIPING ASSOCIATED WITH
UNDERGROUND STORAGE TANKS
This form may be used to document that suction piping systems (“European Style”) associated with underground storage tanks
meet the design and construction criteria set forth in 40 CFR 280.41(2)(i) – (iv). Suction piping systems that are not subject to
secondary containment requirements and that meet these criteria are exempt from leak detection monitoring requirements.
The form must be completed by the installer of the piping or by a UST petroleum equipment contractor who has personally
examined the piping.
Tank owners and operators should keep this form at the UST site or their place of business for the life of the piping system.
The form must be available for inspection by the UST Section.
NOTE: All suction piping installed after 11/1/2007 is not exempt from leak detection and must have secondary containment
monitoring and have a tightness test conducted on the primary and secondary piping every three years if the piping is
monitored by sump sensors.
Please print all information below
I. PIPING INSTALLER OR UST PETROLEUM EQUIPMENT CONTRACTOR
NAME:
TITLE:
COMPANY NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
WY
II. UST FACILITY
FACILITY NAME:
UST OWNER:
FACILITY ID NO:
STREET ADDRESS:
CITY:
COUNTY:
Yancey
III. USTS WITH PIPING MEETING DESIGN AND CONSTRUCTION CRITERIA OF 40 CFR 280.41(2)(i) – (iv)
TANK NO.
TANK CAPACITY (GALS.)
PRODUCT STORED (e.g., DIESEL, MID-GRADE GAS)
Attach additional copies of form if necessary.
IV. CERTIFICATION
On
(date),
I installed/examined (circle one) the piping associated with underground storage tanks at the
location listed in Section II above. Based on my knowledge of the piping at this location, I hereby certify that the piping
systems associated with the underground storage tanks listed in Section III meet all the following criteria:
(1) The below-grade piping operates at less than atmospheric pressure;
(2) The below-grade piping is sloped so that the contents of the pipe will drain back into the storage tank if suction is
released;
(3) Only one check valve is included in each suction line; and
(4) The check valve is located directly below and as close as practical to the suction pump.
SIGNATURE OF PIPING INSTALLER/UST CONTRACTOR:
DATE:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF WASTE MANAGEMENT, UST SECTION
1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646 PHONE (919) 707-8171 FAX (919) 715-1117
http://www.wastenotnc.org/
3/2018
CERTIFICATION OF LEAK DETECTION EXEMPTION
UST-19
FOR SUCTION PIPING ASSOCIATED WITH
UNDERGROUND STORAGE TANKS
This form may be used to document that suction piping systems (“European Style”) associated with underground storage tanks
meet the design and construction criteria set forth in 40 CFR 280.41(2)(i) – (iv). Suction piping systems that are not subject to
secondary containment requirements and that meet these criteria are exempt from leak detection monitoring requirements.
The form must be completed by the installer of the piping or by a UST petroleum equipment contractor who has personally
examined the piping.
Tank owners and operators should keep this form at the UST site or their place of business for the life of the piping system.
The form must be available for inspection by the UST Section.
NOTE: All suction piping installed after 11/1/2007 is not exempt from leak detection and must have secondary containment
monitoring and have a tightness test conducted on the primary and secondary piping every three years if the piping is
monitored by sump sensors.
Please print all information below
I. PIPING INSTALLER OR UST PETROLEUM EQUIPMENT CONTRACTOR
NAME:
TITLE:
COMPANY NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
WY
II. UST FACILITY
FACILITY NAME:
UST OWNER:
FACILITY ID NO:
STREET ADDRESS:
CITY:
COUNTY:
Yancey
III. USTS WITH PIPING MEETING DESIGN AND CONSTRUCTION CRITERIA OF 40 CFR 280.41(2)(i) – (iv)
TANK NO.
TANK CAPACITY (GALS.)
PRODUCT STORED (e.g., DIESEL, MID-GRADE GAS)
Attach additional copies of form if necessary.
IV. CERTIFICATION
On
(date),
I installed/examined (circle one) the piping associated with underground storage tanks at the
location listed in Section II above. Based on my knowledge of the piping at this location, I hereby certify that the piping
systems associated with the underground storage tanks listed in Section III meet all the following criteria:
(1) The below-grade piping operates at less than atmospheric pressure;
(2) The below-grade piping is sloped so that the contents of the pipe will drain back into the storage tank if suction is
released;
(3) Only one check valve is included in each suction line; and
(4) The check valve is located directly below and as close as practical to the suction pump.
SIGNATURE OF PIPING INSTALLER/UST CONTRACTOR:
DATE:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF WASTE MANAGEMENT, UST SECTION
1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646 PHONE (919) 707-8171 FAX (919) 715-1117
http://www.wastenotnc.org/
3/2018