Laserfiche WebLink
STI SP001 AST Record <br /> Form completed by(Name) Date <br /> (Title) <br /> OWNER INFORMATION FACILITY INFORMATION INSTALLER INFORMATION <br /> Name Name Name <br /> Number and Street Number and Street Number and Street <br /> City,State,Zip Code City,State,Zip Code City,State,Zip Code <br /> Regulatory facility ID number(if applicable) <br /> OWNER'S TANK ID OTHER ID INITIAL SERVICE DATE <br /> Manufacturer: Contents: Construction Date: Last Repair/Reconstruction Date: <br /> Dimensions: Capacity: Last Change of Product Date: <br /> Design: ❑ UL ❑SwRI ❑API ❑Other ❑ Unknown <br /> ❑ Horizontal ❑Vertical ❑ Rectangular <br /> Construction: ❑ Bare Steel ❑Cathodically Protected(Check one:A.❑Galvanic or B.❑ Impressed Current)Date Installed: <br /> ❑Coated Steel ❑Concrete encased steel ❑Stainless steel ❑Other <br /> ❑ Double-Bottom ❑ Double-Wall ❑ Lined inside;Date lining installed: <br /> Spill control: ❑ Earthen Dike ❑Steel Dike ❑Concrete CRDM: ❑yes ❑ no <br /> ❑ None ❑Other If yes,type:❑ Release Prevention Barrier❑ Elevated tank ❑ Double bottom tank <br /> Tank elevated on supports ❑yes ❑ no ❑ Double wall tank ❑CE AST El other <br /> Support material: ❑steel ❑concrete ❑ other <br /> Release Prevention Barrier: ❑yes ❑ no If yes, Date Installed: AST Category: ❑Category 1 ❑ Category 2 ❑ Category 3 <br /> If yes,Type:❑concrete❑synthetic liner ❑clay liner ❑ steel ❑other <br /> AST Record Page 1 of 2 <br />