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�m.�^'�'ti' .3 '""h ,,. .i%` tixi�q*Y•., 'b."t` ��Y:S,i=. "m k ,,.;J' ,.'�a'+@ :.i ;3 . ..ri1 +�+ <br /> GENERAL <br /> 1. One t. YIeM 13.:.shacll be fe°ompicted for each ureal, for all NIW PERWIN,PE?RMU(11 GES, E W, ALS and/or a.<an- <br /> othcr 1'AN .I FORMA' I)1d(i 1A C1Elk <br /> ..,. 'Ins form should be completed by either the PIlit `I.APPLI '.AMF or the.LOCAL AGENCY UNDERGROUNDTANK <br /> ('l ; ot,pvn. c ry all to laes;te,d informations <br /> 4U'sc!a h':Mldy,oaat w t rlt >nsrrurn rrl,you are.rnaaking,3,copies. <br /> TOP OF FORM:'MARS ONLY ONE,1`Iv,,%w <br /> I, Mark an (X) in the boy: next to the item that Lest describes the reason the Briar is being compfvted4 <br /> Indicate the DBAor Facility name where the tank is installed, <br /> I. "I'ANK DUSCI1I TIO -C.OMPLIn'1I AI,E,HEMS-IF UNKNOWN- )SPFX31 Y <br /> 1v Indica;c: owners tank It) _ If there is a tank number that is used by the owner to identify the tank(ex.AB70789). <br /> 13 <br /> M. Indicate the name of the company that manufactured tate tank(ex.ACMr IAh� FC;). <br /> C. Indicate the year the tank was installed (ex. 1987). <br /> Indicate the tank capacity in gallons(ex. 25,00l)or Ip,{:Xk}etc.). <br /> 11, TANK WNIENIN <br /> A 1.if MOTOR VEHIC.l,F;1711Y L,check box 2 and c°otuplete items 13 & C. <br /> 2.If not MOTOR VEHICLE F L?L,check the appropriate box in section A and complete items B & D <br /> E3. (Beck the,appropriate box <br /> C;. C;"hecs "he type,of NJOTOR V11111IC LE'FUEL(€f box 1 is checked in A). <br /> 13. Print the chemical name of the bacaaralous substance stored in the tank and the(;.A,S, .(Chemical Abstract Se:nsice <br /> number),if box 1.is NOT checked in A. <br /> IIL TANK CON,3TRUCNION-NlARK,t"; I;IrFM ONLYI IN I3f:) )�,11,C&D <br /> 1, Check only one item m'pYPE Cai fSY,S FNK"ANK MA'1"F"RIAL., IN I"FiiUOR INNING and CORROSION'1'ROTE C'I"IC)ti. <br /> 3, If 0TI117R, priest in the space:provided. <br /> (. Circle?Y if ab e grnund; circle 1 if and ;rgrount and care both if applicable. <br /> h. If UNKNOWN. cirelc� or if OTHER,print i <br />