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Tracy iv.azda Waste Anti-Freeze Tank Assessment kLO09) <br /> Integrity Assessment Inspection Checklist <br /> (wileral h&)rmation <br /> Site Name: Facility Cont}-t: C:nntact'Tel No.: Date: <br /> Site Address-Ac, X .pL Tank Contents: <br /> street rrr �'�� jqp City: zip:1 t�+4d T <br /> Tank Id(if amyl Grins( capacity: <br /> LYr k h f Tank Model: <br /> a <br /> 'Tank Configuration(long.dimen.) Dimensions: <br /> n ! Rectangular Tanks: L;_ W: H: <br /> ❑Horimntal ,Wcrtacal r C liodrlcal Tanks: Len h;02�fliirn­so- <br /> Secondary Containment <br /> "Tank: ❑ lntcL,,rdl DW Tank❑Comainment berm ❑ Controlled Drainr'Sump 19 None <br /> 2I Dthcr(dcscription)_ elf//t/f,( - r/ &anft- <br /> Piping. ❑ Integral DW Piping❑/Containment berm ❑ Controlled DraiwSump ❑ Nonc <br /> ilthcr(dcscriptinn) �a� 6eOFt. <br /> Tank Primary Containment Material ❑Steel ❑ Fiberglass Other Wall Thickness_ <br /> Tank Secondary Containment Material ❑ Steel ❑ Fiberglass D Usher Wall Thickness &Tone <br /> ri <br /> Piping Primary Containment Material ❑Steel ❑ Fiherglass f�Other b�r Diameter 1 <br /> Piping Secondary Containment Material ❑Steel ❑ Fiberglass 0 f0thcr —7r�t�amctar(in_.)— ❑None <br /> Description/Comments: / --- <br /> Other Equipment _ —KY <br /> Of-lump,Internal(type,size) Pump.External(type,size) <br /> ❑Day Tank ®Drain Table ❑FilierCrush ❑Other kFlectronic Monitor(Mfr,rvIudel) <br /> -r <br /> _ <br /> VV <br /> DescrlplfonlCommenls:__.— _ <br /> tocg's Available" C1 Yes No <br /> Is Tank.inside Building or Covered? Leakiest or In+ tion A-,ail? <br /> C Yes❑ No ❑ Ye,' o if Yes,Date— <br /> T1 <br /> L7ab <br /> ld I*rc«nt 2.3p ;/,wAccuTn <br /> Smotting ❑ ProductDescription ifazardousWaste.❑ Absent Start Date ❑ LIL Std No. _ ❑ Other ______ <br /> Strandberg Associates 1(866)388-0404(650)329-8918 rwatergtiy@rwaterg<ty.COM 15 <br />