Laserfiche WebLink
CES CONTE BOARD <br /> ,�ATERREs°UR TANKPR�GRAM �:: <br /> GE TION <br /> INF�RMpNFOREACHTANK.- <br /> IC P'I INFORM <br /> `�0� � ORMW PPHEFOLLOWINO ❑7 NTLYCLOSEDTANK <br /> --=V�ATION <br /> 6 CHANGE OF - -ANTT P£WJVED <br /> F GPS (P ❑3 RENEWALPERMIT cl 6 TEMPORARY GLOSUFE <br /> FARM TANK-YES❑ NO <br /> O VERS,/ ❑4 AMENDED PERMa I C <br /> cop �. <br /> -MSTALLED: 50 SPECIE( <br /> LETE ALL ITEMS'If U14KN0 — B MANUFACTURED BY 5 <br /> E^ l�I D.TANK CAPACITY IN GA Ul <br /> co,_ fTEY D. � _ <br /> ovv EO EM 1 IS NOT MARKED' ft <br /> rtEM C.IF(A. L C ❑1 _ <br /> O� S1SEr _i.ET FUEL �c A.MTION GAS <br /> G\ IF(A•1)1 IS MARKED CO1E B. ❑4 - <br /> ❑T _ OTHER(OESCR�NII610.Ba0W) <br /> 4P Ti'�`,LE FUEL ❑2 PETROLEUMS,/ PRODUCT <br /> I..f g5 UNKNOWN ❑2 WASTE <br /> P III UNKNOWN <br /> 111 rrr <br /> \•� �,�pRODUGT CAS.t <br /> ❑80 EMPTY <br /> DOUS e <br /> ,0TOR VEHICLE FUEL,ENTER NAME OF ITEM ONLY IN BOK A,S1 C'&D 1 <br /> ,0005 SUBSTANCE STORED&C.A.$ ARK ONE ❑95UN. <br /> pNK CONSTRUCTION WITHDD gR ❑Be 0 <br /> 3 SINGLEWALLFD <br /> ❑1 DOUBLEWAL!EU ❑4 SECONDAM COMAMIBIT ❑4 6 wIFBERGIASS REINFORCED PLASTIC <br /> .TYPE OF 2 SINGLE ❑3 ' '� C361 NElCOMPATIBLE FRP <br /> SYSTEM ❑ ❑2 STAINLESS STEEL <br /> C]I STEELIIRON ❑6YVINYLCHLORIDE ❑7 ALUM 99 <br /> g,TANK ❑5 CONCFETE ❑10 GNVANIZED STEEL ❑ <br /> 95 UNKNOWR ❑ <br /> ❑y INNG <br /> MATERIAL ❑9 BRONZE ❑3 EPO%'UNLNc ❑ <br /> ❑2 ALKYD LINING <br /> ❑1 RUBSERUNED ❑6 UMIN® ❑YES ❑NO ❑ <br /> ❑5GLASSUNING 16pAMETHANOI? ❑ISS REINFORCED PLASTIC <br /> C.INTERIOR 3 VIWLW!U`P <br /> LINING ❑IS LININGMATERIALCOMPATIBLEW!D! ❑ <br /> 1 POLYETHLENEWRAP ❑91 EASPHALT ❑95 UNKNOWN <br /> D. BLE <br /> CORROSION ❑ IF UNDERGROUND•g/P!LIUA99 OTHER <br /> PROTECTION 5 CATHODIC PROTECTION ❑ <br /> TION CIRCLE A IF ABOVE GROUND, U A U 3 GRAVITY. <br /> A U 2 PRESSURE A U 96 UNKNOWN A U 99 OTHER <br /> INFORMA p U 3lINEDT <br /> IV. PIPING A U 1 SUCTION p U 2 DOUBLE WALLED A U 3 POLYVIP (PVC) A U 4 FIBERGLASS PIPE <br /> EM TYPE U 1 SINGLE WALLED A U 8100%METHANOL COMPATIBLE FRP <br /> A.SYST <br /> A p U 2 STAINLESS BTFFL A U l STEELI <br /> g.CONSTRUCTION p U 1 STEEIIIPON A U S CONCRETE A U 99 OTHE <br /> A U 5 ALUMINUM EEL A U 95 UNKNOWN IpY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> C. <br /> MATERIAL A U 9 GALVANIZED ST PRIMARY•OR S FOR SECONOP <br /> p FOR �41C MONITOR P S 5 GROUND WATER MONITORING WELLS <br /> SYSTEM CIRCLE 'N <br /> DETECTION B 3 VAON DOSE P P S 99 OTHER <br /> P S ¢ INVENTORY RECONCILIATION P 91 IN <br /> V, LEAK p <br /> P S 1 VISUAL CNECK S 7 PRESSURETESTING TLY CLOSED IN PLAC <br /> P S 6 pREGISION TESTING P pNEN 3.WAS TANK FILLED WITH <br /> TANK PERM 2.ESTIMATED OU A 4 OF NEAT MATERIAL? YE$ NO <br /> FORMATION ON SUBSTANCEREMAINING IN IONS <br /> HI. IN USED IMO/YR) OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> 1.ESTIMATED GATE LAST OF PERJURY,AND DATE <br /> THIS FORM HAc <br /> S BEEN COMPLET <br /> UNDER PENALTY <br /> ED <br /> CANT'S NAME(PRINTED 8 SIGNATURE) <br /> Y �D# TANK ID# <br /> LOCAL.AGENCY USE ONL AOENCY# <br /> COUNTY �� <br /> JURISD� PR). V <br /> PHONE X WITH AREA CODE <br /> ppPRO <br /> OENCYFACIU ID� /O TION DATE <br /> CURRENT LOCA <br /> PERMIT APPROVAL DA <br /> CEIPT# BY. j <br /> PERMIT NUMBER l\ <br /> SURCHARGE AMT. <br /> PERMIT AMOUNT AC TRENT FORMA' NAS BEEN FILED J <br /> CHECK# <br /> A FACILITYISRE pPPLICATI <br /> 117-881 THIS FORM MUST BE ACCOMPANI <br /> DATA PROCE! <br />