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-Section 5. Storage Tank Syatem Information ❑ Check this box If this section does not apply. I <br /> -1-ocaflon Identification Plumber I I <br /> Number of USTs at this iocatton ( Plumber of ASTs at this location <br /> Storage tank system ®Same as Applicant Storage tank system ❑Same as Applicant ❑Same as Owner <br /> owner ❑Other: operator <br /> ❑Other. <br /> Yes <br /> NO Storage Tank Systems) I <br /> �] © 1. At the time of signing this application,do all storage tank systems comply,at a minimum,with the United States <br /> EnWonmental Protection Agency's (US SPA) requirements regarding construction, overf11/spill protection and <br /> teak detection for tanks,piping and dispensing systems? If"no",provide details: <br /> ❑ ❑ 2. Do you have pians to upgrade,repair, remove or replace any of the storage tanks submitted for coverage in the <br /> next twelve (12) months? If"yes", attach a detalled description of the planned activities with a timeline for <br /> activities to be completed. <br /> �] ❑ 3. Do you use a remote monitoring system with an outside vendor,who receives an alarm when a release occurs <br /> and is responsible for notifying the appropriate parties? If"yes",provloe: <br /> --- Name of Firm - <br /> Contact I Telephone - --- - I <br /> ❑ ❑ 4. Are there any tanks at this location that are not registered with the applicable state regulatory agency or that are <br /> not included within this application? If"yes",provide details: <br /> Li 1 11 5. Is the most nxnnt annual storage tank site Inspection report available? If'yes".attach a copy. 1 <br /> I <br /> Tank Details I <br /> Tank Id I � <br /> TypeI ❑BUST ❑ ❑ UST ❑AST ❑UST L AST OUST ®AST <br /> Original Installation nates <br /> Cape,(gallons) <br /> Contents <br /> Construction ❑SW ❑DW ❑SW ❑DW SW ❑DW ❑SW q DW <br /> Is tank equipped with ❑Yes ❑Na ❑Yes ❑No ❑Yes ❑Na ❑Yes ❑No <br /> secondary copal <br /> Piping Constructure°Type: I I Diameter(inches) <br /> Piping Well Construction: []SW ❑DVV ILength <br /> Spill date bucket Instaitation split It bucket testine of most g t spill bucket repair <br /> te of most rlt <br /> Zverage monthly thru put Automatic fuel ❑Yes ❑No Frequency of fuel <br /> ®alk+rts) delivery delivery <br /> — 1-1---- __� _ ._.! <br /> "if coverage far more than four(4) tariks is requested,submit a completed Section 5 for each additional storage tank. <br /> In the piping construction type field,please entartthe description of the equal piping material such as copper,fiberglass,flex,ete. <br /> ENv ORT 100 C CW Qr 19 A AF.y1MV COMPANY Pe"4 O6 <br />