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f <br /> f 4 , <br /> 2018 Equipment Survey <br /> k'� } JAN 0 4 2019 <br /> Site # '1 Ld.`�I Address p 1�2 " � -� P� <br /> dr Its t� <br /> Ir t <br /> Contractor name / name .. <br /> Date <br /> Petroleum Storage Tanks <br /> Tank # Product Capacity UST orAST AST Impact Barrier Split Tank StnkerPiate Auxltary Manifoldod / Siphoned <br /> R = Regular Urleaded Norrinal Ga7ons What type of impact Winer a Spit t <br /> M Mid Grade Nearest 10001 preseno (leave blank for U51s) TSP = Tank Sinker Note - <br /> rdef Gmpartment Auxdary Tank Mandotded 9pDoned flank <br /> P = prenw;m UST = Underground lank 8 = Bdlards F = Fencing Tank DSP : DropTube Nage , <br /> Pat rank 0 o O1CaG Im3l"I lonlh for AST = Aboveground Tank i * insrde Service Bays N = None <br /> mCn+tor W r Waste 0r tanks less than L = Looated away from lratlrc UNK t Unkncwn Yat ar No hl so, to what orbs tank{ <br /> SO¢ atlonsl N = AST resent no hammer Yes or No <br /> H = Heating Cal g p <br /> � <br /> U51 G Yes 3 No <br /> tDsua:� 1 <br /> ANNE <br /> 2 � � © t03� � . 1 �,p y � �( Yes Ile No <br /> NO Yes 1 rZ No <br /> fsr�► Js� 3 �2. _ �o ,oa � U51 VIo \41 I <br /> Yes <br /> totoca -� o N h � <br /> Yes No <br /> 5 <br /> Yes No <br /> 6 <br /> Petroleum Storage Tanks pant Caps <br /> Tank N Material of Construction Corrosion Protection Lined Tank interstitial Space OR only <br /> A 7CA Manufacturer Model # <br /> DWF = Doublevrall Fiberglass Intematly Lined Tank <br /> SWF a S-...nglewall Fibergtass tasDausia m 11°11 °nit B = Orme Does the UST Fit Riser OPW <br /> Cyder DINS = Doublewall Steel IC = Impresscd Current mtr' Neerau i a Clad D a Dry have a tethered grounding H = Husky <br /> txass shave a m,riro Wide Model Number <br /> P <br /> tank SWS = Smglevrad Steel SAC = sac Anode sol VC = Vacuum Cable' M = Morlson Bros m space pros-:ded <br /> mondor DWSP = Doubtinvali SAP NM Non metallc N = None NA ! No Vent mandolded <br /> SWSP v Singlewan SLP Yes Cr No UNK = Unknonri Yes or No NO = No Vent Present <br /> CLO * Steel vat brgls Coating UNK = Unknovn <br /> 3 W UVN <br /> w � M Nv �J 1J Pit <br /> 5 <br /> 6 <br /> Product Piping Vapor Recovery System <br /> Tank # Materiel 01 9lphon Sart Corrosion Stage I Type Stags S teat Pressure Mgmt Swam EVR System <br /> Construction Protection (nozzle reps) <br /> DWF s DW Fibergts ss Does product Masa the tank thru SL a Balance CAS = Healy Clean Art <br /> Order SW'F a S'N Fiberglass the use o1 a Siphon Bar 6 ate the IC = Impressed 2PT = Two Point VA z Vacuum Assist ES'N = EBW 'pR <br /> Separator <br /> per tank SINS = SW Steel connections to each tank visalle7 Current CP z Coaxial Popovied VST a Vapor Systems PT = PHr . LTE <br /> D'NFLX = OW Flexible SV = Siphon d visible SAC = Sac Anode CN = Coanal Nom Tech VR = VR carbon canister OP'N r OPW VR <br /> mondor SW'FLX SW Flexible SNV = Siphon but not visible NM = fionma <br /> • talkC Poppeled HEVR a Healy verNA = Outside o1 EVR VST = VST Vapor of CaliforniaCaliforniaProcessor NA = No PVR <br /> UNK a Unknown UA a Not dispensed by Whom NA = No StegallMINES <br /> 2 ` e ` Vapor Pot one; the sari have a vapor pct (drop out tank)v Yes or No <br /> 3 <br /> Manufacturer Model N <br /> �W 5 UST Monitoring System <br /> Number Software Ver. Tank Probe Location <br /> MINI <br /> panic <br /> VR a Veedet Rool Write n space in spat F =e T = Turbine <br /> e Model Number n si Sump <br /> 4 `� ► N NA = None space provided SurtW <br /> ip provided Other Wnte In <br /> MINI <br /> Issued 12/04/2017 Page 1 of 4 <br />