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OWNER'S TANK ID AR ;,, v;' OTHER ID Ictal! 2 1 INITIAL SERVICE DATE <br /> Manufacturer: VS. Contents: 50 Construction Date: 0'///q 2 Last Repair/Reconstruction Date: <br /> Dimensions: Le L `j° <br /> Ca acit : 12, QM /oat Last Change of Product Date: <br /> Design: ❑ UL ❑SWRI ❑API ❑Other ❑Unknown <br /> -S Horizontal ❑Vertical ❑ Rectangular <br /> Construction: ❑Bare Steel ❑Cathodically Protected(Check one:A.❑Galvanic or B.❑Impressed Current)Date Installed: <br /> Z Coated Steel ❑Concrete encased steel ❑Stainless steel ❑Other <br /> ❑ Double-Bottom ❑ Double-Wall ❑ Lined inside; Date lining installed: <br /> Spill control. ❑Earthen Dike ❑Steel Dike Concrete CRDM:;9yes ❑no <br /> ❑ None ❑Other If yes,type:❑ Release Prevention BarrieraElevated tank ❑ Double bottom tank <br /> Tank elevated on supports eyes ❑ no ❑ Double wall tank ❑ CE-AST ❑other <br /> Support material: steel ❑concrete ❑ other <br /> Release Prevention Barrier. N yes ❑ no If yes, Date Installed: AST Category:M Category 1 ❑ Category 2 ❑ Category 3 <br /> If yes,Type:,®concrete❑synthetic liner E]clay liner El steel ❑other <br /> OWNER'S TANK ID rq ,' OTHER ID --1,,,k 3 INITIAL SERVICE DATE <br /> Manufacturer: e(" v6 Contents: ¢ A Construction Date: J-ZC)nj Last Repair/Reconstruction Date: <br /> Dimensions: 4,1010 J7 r Xcrin4t,, " o' Capacity: '0160C r411AkcLast Change of Product Date: <br /> Design: ❑UL ❑SwRI ❑API ❑ Other ❑ Unknown <br /> Horizontal ❑Vertical ❑Rectangular <br /> Construction: ❑Bare Steel ❑Cathodically Protected(Check one:A. ❑ Galvanic or B.❑ Impressed Current)Date Installed: <br /> Coated Steel ❑ Concrete encased steel ❑Stainless steel ❑Other <br /> ❑Double-Bottom ❑ Double-Wall ❑ Lined inside;Date lining installed: <br /> Spill control: ❑ Earthen Dike ❑Steel Dike K Concrete CRDMAQ yes ❑ no <br /> ❑ None ❑ Other If yes,type: ❑ Release Prevention Barrier Elevated tank ❑ Double bottom tank <br /> Tank elevated on supports Xyes ❑no ❑ Double wall tank ❑CE-AST ❑other <br /> Support material: .Ksteel ❑ concrete ❑ other <br /> Release Prevention Barrier.*�Kyes ❑ no If yes, Date Installed: AST Category: Wategory 1 ❑ Category 2 ❑ Category 3 <br /> If yes,Type'concrete❑synthetic liner ❑ clay liner ❑ steel ❑other <br /> AST Record Page 2 of 2 <br />