COMPLIANCE INFO 2000 - 2004 - Laserfiche WebLink

Home Browse Search

IN1 f OP I WI PPI (lilt MN/17>I Ens! OJJIce Bax .16 Iliurnlr)n, If 'a. 956,86 (200) 794-0102 FAX 794-0112 (.enernl tutor ndnlion Facility Namr: ..__..__..�0 B.S ✓r"�r v°/ do fa t a/ IfidR. No).:- Site Addtrss; Cify: ifl%4.'�'�v r'•B�d ./ C.04.'!... Facility CimIncl Prisms 1'nntnrl 1'fu nu• Nn.' Makr/Ahnlrl of Afanilar ing rymrn[ C�l I logo i-ND CAI(2. Irntr r,l lr.^.line/tier vie inK: 3 / Ii. Inventory of 1'.gnipnn•nl '1'emetim 'ru Iilira (]reek the split ro,role boxes la Indicate• aclllc r n ill nnnrr.I I ,,rnrl....i r.b Tank 111: ,v/_ _. /4;)4-Of 'I nd, Ile• UIn-Tank(W,ping l'n.br. Atndrl• L I In I unk (raurbrg l•n.br Mo.Ip.h. _----___ U Annular Sparc no Vnull Sri nor Af 'drl 1TD V6-q U Annolm Slmrr m Vnall Srnsm. Mrxlrl: 0,QQclD U ripi.g Snmp/'I troth Sr......Is) Mndrl' L11'Tping Sump/'Irrnrh Sr......la U nd Snmp Snumt.l. Aiodrl U I'M Sunq.Sr......(,I. U Mechenirxl l.lnr I ink I irir.v... MndrP U Air,h ndrnl I Lir I risk I/rlrrlm, O Plecinnde I.irr Leak I/elrrrrn.. At.nIrl.. U Er,c(ronic Lh.r Irnk 1ierrrlor., M.xlel: O Tank Overfill/Ifigh-Trvri Smrsnr. Mudrl: U "lank Overfill/Iligh i rgrl Stumm. Model: U 011ier(Ppwlry a ui nrent type and nrudel in Secliun C on Pu e 2 . U other(specify equipment t m and n Adel In Section B on Fertile t . Tank Ir)( 0, � 4•rt/ Tank 111: d7lc LC/ 13 In-Took(iauging Endre. Madel• U III'fmik(:ranging Prnhr. Mm1el:_ J Annular Space or Vaull Sensor. Mndrl:�/yQ'�9L7/��'00 U Ananias Space ar Vaull Sei nr. Malel: J Piping Sump/Tlencll Senso,(s). Mmlel: U Piping Snngr/'Treitel,Srn+or(s). Mmlel: J Fill Sunq.Semm(s), Alallri• U 1111 Small Srnsor(s) Mo(Iri: J Mechanical Line Lenk Orleclnr, AfinTrl• U MrAmnicaf Lire Irnk Drtrrlor. Mrdel:-_ J Electronic I.Ine Leak Detertat. Model: U lilerunnic Une Lrnk Detector. MaIEI: _- J Tank Overfill/Iligh-I rvel Sensor. MmIrl- U 'funk Overfill/I ligh-I evel Sensor. M,xlel: J ihher(specify uI ment I re end model in Secliun E nn I'llgr 2). U Other(specify n ul mKnt f ro and nardel In Secilon P on Pae 2). Fank ID: _-- -- 'Tank III: .__.._.... . .. .--- J (n-Tank Gauging Probe. Model: U Ian fork flanging 19nhe Mmlel: J Annular Spam n Vnull Sensor. Model: . U Ain elm Spore mr Vault Sensor. Mmlel: J Piping Sump/Trench Setnor(9). Mrxlel: U Piping Smnp/Trench Sensor(s). Mmlel:_ ] Pill Sump Sce nr(R). Mmirf: U Fill Sunq.RrnsnNs). Madel:- .. .___.._ - J Mechanical Line Ixnk helrri'll. m".10, U Alreinuirnl Lire.I call I/etrri o. M.xIEI: ] ElectroniC Line Leak Deleclar. Kindel; _ U Fleelmni•Line Leak hrtealm. Mallet:T- 7 Tank Overfill/Iligh-Level Sensor. Model: _.._ _ _ .. U '1 milk Overfill/1lbglrl.evel Sensor. Model: 7 other(specify equipollent type and mallei in Sectimr C on Pri e 2). U Other(specify a ui mmol type and nuldel in Section E on Page 2). rank His —._--_----_ Tank 111:-----...._. .__--. .....- 3 In-Tank(barging Prole. Mndrl: .. _ U hr Hulk(inuging 1'nrbe. M041e1:_ J Annular Space lit Vnmh Sensnr. M(xlel: . U Armulnr Space or Varll Sensor. Madel:_ J Piping Surnp f Trench Seimm(s). Madel:. U Piping Snmp/Trench Srtrsor(s). Mallet: J 1711 Sunip Semni(s). MAO- U Fill Srngr Seosnr(s) Mo(fel: _ _- J Mechanical Line Ixak Delcetnr. MmIrl• U Mrrirrrrie.1 Line Irnk Drlechn, Model: J Electronic Hite Leak Deicc nr. Kindel: U 111rruunic Line Lrnk Iietrulm. MoTei: J Tank Overfill/Iligh-1,.vel Season. Model: U 'l link Overfill/I ligb-I evel Sensor. Mattel: J 011ier(specify ui mlent type end model in SeCIIIIII P o%1'11 e 2). 1 U Uliu(specify e(ui anent I ie and llKxlel in Section E on Pae 2). If The facility contains smile tanks nr dispersals,copy this from Include infunnntinn fur curry tank and disleneer ill the facility. .. Cer lifiCAII1111 -I certify That Iii eyulpux•nl Idrulided In Ihls d,xumrnl was h,greelrNsrrvired In accordance with die rrrnu(acluromrs' guidelines. Attached to this Certification is Infini cellon (e.g. rnunfacluren' ch"lillsts) necessary to verify that this Information to eorred and Is Plot Plan ahnwing the layout of munlln,ing rgalpmrni. For any equipment capable of generating tach reports,1 have also aflached a espy of the rrpnHr(check all that apply): U Syalenn Rel-lip U Alann history report 'eclniiclnn Name(punt): Sirnnune: 'erlilicnlinn Nim r lit rust iia _-- _ 'esfing Company Nnnic: . . _. _ cil'G \�\ I'lume Nil liaga'z of 6 O.V01 1nnllnrlit .4 i'sl ear (•rrlifirnll un