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STI SP001 AST Record <br /> Form completed by(Name) Date <br /> (Tule) <br /> OWNER INFORMATION FACILITY INFORMATION INSTALLER INFORMATION <br /> Name Name Name <br /> Number and Street Number and Street Number and Street <br /> City,Slate,Zip Code City,State,Zip Code City,State,Zip Code <br /> Regulatory facility ID number(if applicable) <br /> OW NEWS TANK ID OTHER ID INITIAL SERVICE DATE <br /> Manufacturer: Contents: Construction Date: Last Repair/Reconstruction Date: <br /> Dimensions: Capacity: Last Cha eof Product Date: <br /> Design: 0 UL 0 SWRI 0 API 0 Other 0 Unknown <br /> 0 Horizontal 0 Vertical 0 Rectangular <br /> Construction: 0 Bare Steel 0 Cathodleally Protected(Check one:A.0 Galvanic or B.0 Impressed Current)Data Irwtalled: <br /> ❑Coated Steel 0 Concrete encased steel 0 Stainless steel 0 Other <br /> ❑Double-Bottom 0 Double-Wall 0 Lined inside;Date lining installed: <br /> Spill central: 0 Earthen Dike 0 Steel Dike 0 Concrete CRDM:0 yes 0 no <br /> 0 None 0 Other If yes,type:0 Release Prevention Barrier 0 Elevated tank 0 Double bottom tank <br /> Tank elevated on supports 0 yes 0 no ❑ Double wall tank 0 CE-AST 0 other <br /> Support material: 0 steel 0 concrete 0 other <br /> Release Prevention Barrier: 0 yes 0 no If yes,Date Installed: AST Category: 0 Category 1 0 Category 2 0 Category 3 <br /> If yes,Type:0 concrete 0 synthetic liner 0 clay liner 0 steel 0 other <br /> AST Record Page 1 of 2 <br />