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<br /> INITIRUC711ONS ISR(1C)MI'LI"I"I`.?'a6, I OKM`11�
<br /> 1r',NEISI,[NSMUC t;101t'sk
<br /> i. Cmc snan be comphned v ach it ,k for .Eii NE"t'"PIyI2M!I'S,PI^`,IC I'I'C1JAN F S, I2 °,+s C1VAIJli?aat4,r,/or any
<br /> z eitne the .` ,, ., e 'fsI.CC i fl ¢ t"tt,c:I C2I,. I, GEN � LfL�I I4.IIC,IIC1LJivi.t'I I
<br /> ` ISL, l
<br /> I Phase 7ysW L v pr.n 4 �:.:
<br /> $. the r h,. `k ar m "WAg tdmmeat,We F?S"4;;making 3;.£om.
<br /> 1., Mark on (X)in the box mot to Me Ant t4t but de.,.::ribcs, the reason the form is being cornplctcd!
<br /> Indivate the DBA or F,'-,. I name ,-hcre the a:a.0 as ivst aia€et1,
<br /> I. TANK DESC RIVI SON-C'C:II IrIJ-a E ALL rLI? IS-II'UNKINK)WN N )SI1EK11
<br /> A� ohne rmtk IPP 0 - IfAvre is a tank munber _rat l umd by the owner to rd ntkf'y the; tank J,ABMM9'),
<br /> 11 indianc Indianthe name of An company€hal anuba£.u.cd 'aL n'a(ex,ACMFTANKMFG,Y1
<br /> C Indicatc the year.he tul ontsInstalled Q. 7ll.a.a1
<br /> TX inWeme the ant c:pa, 'h, in „alkyn.e (ex', 25,sf1"s to t€;1100 coy
<br /> II, TrIc,'`�a'II C°C1 I
<br /> _r
<br /> 1 L7 no SUI c., Al 1a„ ..,HUE ,.. ,..,.,, P a„ t-,Tkn0b£"X in scctkan A and complete items 13 A D,
<br /> 11 (leek the aping .'sett, box.
<br /> C;. (Teck k Hie Inc ofy,101 OR' ri t i ,;:,I. I .,s:i,(I box 1 is cltecAd in A).
<br /> 11 Print the ch:nA a";name oi'tic ha �rdmw s om ame stared in the tank€nd the t:,A,S. . (C hernieai Abstract Service
<br /> number),if€ox I is',tt`f:'achcck.ed in AS
<br /> III.. �I:�. IK(XPhUR1X 1 )N-�b4,ARX.1.NE, z.a,r.,;: 3I F"' age; Da it, 1s, �"�.�:f�
<br /> I. Cire.0 ,,n one he.:^^; in TTPF (A'SYSAIAVEANK .aANI a.ir,i.AL, INFERIOR LINING and C",ORR SION t IItIi � IC3 I.
<br /> 1 If OTHER,, t r no, in thc se,a'c o .`,ad.
<br /> IV PIPING INTFORNfATION
<br /> L ('Irma A if An=a, Vin:>c.a l circle le. t t b'aa� � a ,xt�t _ .,.1 circle both if a iicaabte.
<br /> 1 If UNKNOWN,OWN, ctircic; o ',f f)i t is R 1}� n, .n,, ac provided,
<br /> I I,at iewe tie LEAK 1M,.I.t,I`a,?nd syst ras,c)need to mrnfpl� with the monitoring requirement for file piping,
<br /> V. TANK LT Iit"IVU7110
<br /> L r , ,nd in ,m,t ti.with the nwnitoahg requirements Nr tk tank,
<br /> I. FaURUNHON ON'IANK L°EfC3 a"CNEN'II,y C1, 6F1-)IN PIACE
<br /> 1, FAUi'viSI11)DAB. ASL1,;3q) 1,<p>asII=rIl,.(1,et,Laey, 1998 or 011,>`8I3},
<br /> Z. Im i 3i.',ILiIS„1ta`. , a..al,P, a_; ?,�. .l;..SC= °era a€nlsti int ttte tank(i a Cia£4ts .
<br /> 3. WAS IANK a I t.l. a t,s s 1 .N; ,"D"T. ..a i R,tl, al,. ('heck „Y&or"N'Cf'.
<br /> , PI..£'ANI'MUS17 SIGN AND DNI"I?TIIFI t'ORM AS sra'tfix„1S, UD,
<br /> INS RUC7110 I'CIIC'Idiii I., C:AL A IIIIdC1IICS
<br /> The state tank ihh nth=ic<a u;, n rnhar is composed of the two digit county number, the three digit jurisdiction
<br /> number, the A:d igh r adia a number a cal the sh ea.pa, ;and nun en 11he county and jurisdiction nurnbeas are predetermined and
<br /> can be obt,ane i by c a.;..0 the Store A nni (}.,,IT2 The 1561y number mug he be sarne as sheat in loan "A'. '1"he
<br /> tmk nS.€S's?i,E, way he asigned by f=,e .wGsl fi ..E«h ;.iv.JnnwC€,tt't3;j number i2273st I3£nuzlTe%l£72eS and ca11Cf£1t contain an a$L)ISaI}e$, If
<br /> the cavus, a,. ,q PMIN a,_man n ..0 1", 3 :=;n €h „_.,a nurnt,'r",I)t,aase norve,it thank.
<br /> I"L`IS'I`II61 1,t:'L"si LIaIaAaltlt,f_ I 1;IF . _.3.<,ys CC.,Y'Iasaat`I'INISPI X:M"JIJD FAC111111'0 VFR1F 'n fit
<br /> a(X,'URAC" C)Ir'f"I1E INFORMATION, I r IE f-AOC I,,A(;I°: C IS ICINPONSIBI:E FOR`71E('OMPIXITON OFME,
<br /> 'ICI ' L AGIINCY USE(IDLY"INIfI1ILICI 3100 IQXAND It`f.ER FORWARDING CONI?FORM W AND ASSOC IK.17It1?
<br /> S�EAEIL OF CALIFORNIA
<br /> Ss.1L1 WARN RITTAI a tA ONI° CII,.I11t i
<br />
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