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w KO"A E 'V D <br /> tbp 2016 Equipment Survey FEB 10 2017 <br /> Site Address fJf- <br /> Lq rt+dec <br /> Date Ozaf 17 contractor name Tech name j� ENVIRONMENTAL HEALTH <br /> .- %�' MINT <br /> Petroleum Storage Tanks <br /> Tank# Product Capacity UST or AST AST impact Battler T�k Stryker Plate Auxilary Manlfofded/Siphoned <br /> R-Regular Unleaded Nominal Gellons What type of Impact banter to <br /> M=Mid Grade UST=Underground Order Nearest(000) W present?(leave Maroc for USTs) TSP=Tank Striker Plate <br /> P=Premium Tank B=Bollards F=Fencfn Split lank AuxilaryTank Manifolded/Siphoned Tank <br /> per tank D=Diesel fnearett tern for AST=Aboveground 1_ 8 DSP=OropTubo Slrikar Plate <br /> monitor 0 -Inside Service Bays N Nona <br /> W=Waste Oil tanks lauthan Tank L-Located away from treIfic Yes or No LINK=Unknown Yes or No (if so,to what other tank) <br /> H=Healing Oil 500 salon') N=AST present,no barrier <br /> I 2 s r u 1� fj YEs <br /> 2 r2GoCi I YES NO <br /> 3 �puG L YES <br /> 4 YES NO <br /> 5 YES NO <br /> li YES NO <br /> Petroleum Storage tanks Vent taps <br /> Tank# Material of Construction Corrosion Lined Tank Interstitial Protection Remote Pill CR anA r CA Manufacturer Model# <br /> DWF=Ooublewall Fiberglass Irttemaly l�rted Space <br /> SWF=Singiewall Fiberglass Tank Does the Does the UST Fill <br /> DWS-Doublewall Steel IC=Impressed Current B-Stine remote fill Riser nava a <br /> SWS=Singlawall Steel SAC=Sac Anode c'pp°�6bo"`N1dT1° D=Dry Remote Fill have split OPW Write Muriel Number <br /> wM.rw,�ews ante tethered <br /> DWSP=Doublewall STIP NM=Non-metarfc VC=Vacuum bucket? H=Husky <br /> 'aOid°hi YeO nal N=None Yes or No grounding cable? M=Morrison Bros In space provided <br /> SWSP=Single"llSTiP LINK Unknown LINK=Unknown YES or NO <br /> CLD-Steel Clad w/Fiberglass Yes or No or NA Yes or No <br /> LINK Unknown LINK a Unknown <br /> F, 0 o <br /> 2 - <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> Product Piping Vapor Recovery System <br /> Tank# Material of Siphon Bae? Corrosion Stage I Typo stage If type Pressure M mt stem EVR S stem <br /> ons ctfon Protection (r orae e 8 8y y <br /> ass Doea t nk dlspenee rota <br /> SWF=SW FlbergWss the use of a Siphon Barb IC=Impressed Current BL=Balance CAS Healy Clean Air <br /> Order SWS=SW Sleet are the connections to each SAC=Sac Anode 2PT-Two Point VA=Vacuum Assist Separator PT=PHIL TRE <br /> per tank WRP=Wrapped tank visible? CP-Coaxial Poppeted VST=Vapor Systems Tech VR=VR Carbon Canister OPW=OPW VR <br /> NM=Non-mefatic ON-Coaxial Non•Poppotod HEVR=Healy w/EVR UST=VST Vapor Processor NA=No EVR <br /> monitor 91ee1 OV Siphon,eon,visible LINK=Unknown <br /> FLX=FlBx tele aNV=alphon,opo.not vlsbla NA=No Stage II NA-Outside of California <br /> UNK e NA=No Siphon <br /> S Q <br /> 2 1s Vapor Pot Does the site have a vapw pot(drop out tank)?Yes or No <br /> 3 UST Monitoring System <br /> Printer I Manufacturer Model Number Software Ver. <br /> Does Monitor VR=Veeder Root <br /> 4 have a Printer Write Model Number in space Provided Wdte Software Version <br /> Yes or No NA-None in space provitlutd <br /> 5 y�`5 V /e cS3�vb D� <br /> 6 <br />