COMPLIANCE INFO_1986-1996 - Laserfiche WebLink

Home Browse Search

I' NCS OR "II" Ii'�a I' 3C.ICTS FOR C.C9 � � 1. One I O M"FI"shrill be completed for each tank for all NFW MIR ',S,PERmn'CHANG13S, REMOVAUS and/or any otherTANK'AN INIAMMA7110N 01ANG& I. This form should be completed by either the ISE I'@'AI"I'IIC.AM'or the LOCAL AGENCY UNDERGROUNDTANK INSI'IE .[OR 3, Please type yr print clearly all recguested'information. 4 Use a hard point uniting instrument,you are making 3 copies. TOP OF MRM-WARK WARONLY Oblti num, 1; Mark an ()C)its the box next to the item that hest describes the reaison the form is bring completed. 2. Indicate the D13A or Facility name where the tang is installed. 1 "TAMC DUSC RIP11ON-C OMPI 1C ALL TITWS-Ill II C) -SO SPIXIFY A. Indicate owders tank II.)#-If there is a tank number that is used by,the owner to identify the tank (ex,AII70789). I3. Indicate the name of the,company Haat manufactured the tank(ex.ACM °I"ft NK MFG,). Cl. Indicate the year the tank was installed(ex. 1937). t). Indicate the tank capacity in gallons(ex.251(W or 10,000 etc.). II. TANK C OMIE`sS�t'I i A. 3. If' ffl.'ORV11ITCL FUI1.,check box I and,complete items B& C. 2:If not C37I' IL VIMIC'1,f FUL,check the appropriate box in section A and complete items 13& D. 3 Check the appropriaate bo`;, C" Check the type of IMO'I`OR VVI Its C I?FUEL(if box 1 is checked in A). D. print the chemical name of the hazardous substance stored in thetank and the C.A S. . (Chemical Abstract Service number),if box 1 is NOTchecked in A Ill. TANK C`,C?NI"TZI1C'I ON-MAIM ONE MW ONLY IN 13OX ,II,C".&I) 1.: Check only one,item in,TYPE P IERIOR 11NING and CORROSIONI'ItC9`I'I:MION. 2', If C)'I'ILM,print in the space provided, . I'tlrl" C"a NI I"C)I . Circle A if above ground;circle U if underground;and circle both if applicable. 2. ,If UNKNOWN,cirele,;ar if(IF" ,priest in space provided, 3. Indicate the LI .DF I`Ia.C'I`ION system(s)used to comply with the monitoring requirement for the piping, , V. TANK LMK DUMMON 1, Indicate the LEAK T9 7I;C'I"If:N systems) used to complywith ith the monitoring requirements for the tank. VI. II3(y3 AY C ) C) I�I?It ISI; I1 C'I saI'D I' <C I? L E5111MATED I)A"t"F 1AST I SF"D-MC MFII/YEA (January, 1988 or 01,18 8). 2. ESTI NI`I )C)C Af4I`I"IY of ILNZA}ZDOUS St.BITI'ANC E remaining in the tank(in Gallons). 3. WAS'I`ANK ILLF'D 171-11 INEM' XrE, C)AL? Check ck'Yes'or'NO'. APPIXY&MF I"S GN ANT)H3MI ° 'III?1K)RM AS I I(WIT-I). The state underground storag;c tankidentification number is composed of the two digit county number,the three digit jurisdiction number,the six digit facility number and the six digit tank number. The county and jurisdietton numbers are predetermined and can be obtained by calling;the state Board(416)739-2421. The facility number must be the same as shown in form"A.". 'Ie tank number may be assigned by the Local agency, however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank numbers please leave it blank. "I'IS THE RINPONSIBIU17Y 017 T1W,LOCAL GEN(Y 1`IITXI'INSI"LtA.'1N-`F ilia FACIILIT "C1 VERIFY1,111? ACCURACY 017111 INFORMAMON. ME UXYU,AGIlNOY IS RIASPO S BBI FOR 1III7 COMPUMON 0171111i a aI C)C` AGENCY TSI ONLY"INFORMS110N BOX ANI) IC a R ARDING ONE,FORM"A"AND,A.' C.IA110 1K)R "I"(s)`I 3 11I3 FSC>I10WI G ADDRIM. SI`NFE CSP CALIFORNIA P.O13OX 527 PARAMOUN17,CA 90723 t '.