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I PRX.)('110N;' <br /> 1. Eyrie.t .,ELM I s'„aa t be eompleted f€; each cank for all NITW PERN(DS,1 ERmr1`C I NGE , HMI ONC I S and/Or carry <br /> other '..,SNS INI4(IIC INITON(A IANGH. <br /> This as fs.,rr should l:=c;completed tei ljy either the It1;I(MrI' PP1;C` ' or the .( :AL AGENCY I S I�IiRGROII I)` A <br /> INSPI1 R <br /> ., Please Te or pariah clearly,all requested information, <br /> .`S <br /> ae+ 3,rrss iJtaTt 'rStia3 } s"Y"u2 <br /> 'FOP 'MARK ONEY ONE ITEM' <br /> L y1ark an (X)in the taeb� nd-st to the Stent that best describes the reason the form is being completed; <br /> , Indicate the D13A,eay Facility name where the tank is instal€ed. <br /> I, TANK DINS I ZION-C OMPI 17i Au,nims-'fir UNKNOWN-SO,IIPECIFT ' <br /> Indicate owners tank 11) #-If there is a tank number that is used by the owner to identify the tan{ (ex.AB`70789). <br /> I). Indicate the name:of the company that manufactured the tank (ax. C;fv E'I'tYi4 MFG). <br /> C, Indicate the;year the tank was installed (ex, 2987), <br /> 1), Indicate the tan],capacity in gallons (ex.25,000 or 10,000 etc.), <br /> IL TANK(X)MIENIN <br /> A, 1, If M(-)'-['OR VEI11CLF'FUEL,creel;box I and coni fete items B& C. <br /> 1 If not MOTOR VEHICLE F IT,clae€:k the appropriate box in section A and complete items B&I). <br /> ,> taatck she appropriate box <br /> C' Check the tyce of MOTOR VEHICLE FUEL(if box I is checked in A). <br /> 1. Print the chern.cal name of the hazardous substance stored in the tank and the('.A.S.#.(Chemical Abstract Service <br /> number);if box 1 is NC7SI:checked in A. <br /> 111. TANK C ON L3 "I'1()1 -MARK ONF Y11W ONLYIN 13K)X A,II,C:c <br /> 1. Check only one item in"3'1'PE 01'SY,;T'I',,M,'I'A K NIA''1f12IAI,, INITi dIOR IANINC1 and C"C7IZIrOSION F'Itt)"I'I:: <br />