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E � <br /> .77 <br /> by / zui ts tquipment survey <br /> ED <br /> Site# 1�� Address--?u���0 Cs,1 sroy" JAN 18 201$ <br /> Date (g Contractor name/Tech name ��'�� ,,� ���iTA.?_ HEALTH <br /> ,:z �� Petroasum _ Tenkvn'r4 <br /> Tank i Product Capacity usT or An AST ImPsd Barlar 9p�t Tank Straker Plats plenary NW0&ded/4I1&wwd <br /> R=Regular Unleaded Nominal Gallons What type of Impact banter Is <br /> Order M=Mid Grade Nearest(000) present?(laevo blank for Usiq Split/ TSP=Tank Sti-ker Plate Manibded/Siphoned <br /> partank P=Premium UST=Underground Tank B=Boilards F=Fencing Compartment Tank DSP=DropTube Cage Awdlary Tank Tank <br /> monitor D=Diesel (nearest tenth for AST=Aboveground Tank I=Inside Service Bays N=None <br /> W=Waste Oil tank■I—men L=Located away from trafryc UNK=Unknown Yes or No <br /> H=Heating Oil 600 Wlom) N=AST present,no barrier Yes or No Of so,to whet other tank) <br /> � �� � ,• ` �S� I es No <br /> 2 �>JUt� NJ� TS e I No <br /> 3 �� _`�� / �`, � � Yes <br /> 4 Yes No <br /> 5 Yes No <br /> g ___TYes No <br /> Petrobtaq,:- T � xr 4 tz r ma vent caps Aviv, <br /> Tai1r 1 aHaEeslel of gCavrrotlott RtaEaclten Tank YfbMmalOft/WA I CA <br /> rats �� .t�asr�c Hca ,m semis ° <br /> DWF=Doublewall Fiberglass 7enk <br /> SWF=Singlewail Fiberglass 8=Brine Does the UST Fill Riser OPW <br /> Order DWS=Doublewan Steel IC=Int Current tegooa.to.a*Cb <br /> pressed my,shmiki+e+a rD=Dry have a tethered grounding H=Husky <br /> per tank SWS=Singlewa0 Steel SAC=Sac Arcade t.ov,eoua be e,.ke nna VC=Vacuum noble? M=Morrison Bros Write Model Number <br /> monitor DWSP=Doublewall STIP NM=Non-metallic m) N=None NA=No Vent,manifolded in space provided <br /> SWSP=Singlewall STIP LINK=Unknown Yes or No NO=No Vent Present <br /> CLD=Steel w/Fbrgis Coating Yes or No <br /> 3 'jm ✓ <br /> 4 <br /> 5 <br /> 6 <br /> is "fir Yi��Prodliet B s Y R-6-Y SY+t— <br /> rartk.a rof (nom e htiee Prseata a M n� �vR sys�'"rib <br /> DWF=DW Fiberglass Does product leave the tank thru BL=Balance <br /> SWF=SW Fiberglass fire use of a Siphon Bar 8 are the IC=Impressed 2PT=Two Point VA=Vacuum Assist CAS=Healy Clean Air EBW=EBW VR <br /> per <br /> bander SWS=SW Steel connections to each tank wsibla? Current CP=Coa>�I <br /> Poppeted VST=Vapor Systems Separator VR=VR Carbon Canister PT=PHIL TFE <br /> tank DVVFLX=DW Flexible SV= on&visible SAC=Sac <br /> monitor Siphon Anode CN=Coaxal Non- Ted VST-VST Vapor OPW=OPW VR <br /> SWFl.X=SW Flexible SNV=Siphon but not vlsiWe NM=Nonattetallic poppeted HEVR=Healy w/EVR =Outside off Californiapyq=No EVR <br /> UNK=Unknown NA=Not dispensed by siphon NA=No Stage II NA <br /> DWS PA- NYA SPT VS-T77 6A6 oPI-) <br /> 2 w G ` U � ) yaps P«;; Does the ane haw a vapor pa(drop oil t�kn Yes or No <br /> 3 NusT 8rram <br /> Vo ^ <br /> �Ya�md cit el ila tmi4 So�Rware i- ` Tank <br /> VR=Veeder Root Write Model Number M Witte Software F=FIA Sump <br /> 4 NA=None space provided Version in apace T=Turbine Sump <br /> provided Other:Write In <br /> 5V� 33 y.aL <br /> 6 <br /> e�r���rnenni� Pane 1 n <br />