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AST Record Page 2 of 2 OWNER’S TANK ID OTHER ID INITIAL SERVICE DATE Manufacturer: Contents: Construction Date: Last Repair/Reconstruction Date: Dimensions: Capacity: Last Change of Product Date: Design: UL ______________ SwRI ______________ API ______________ Other ______________ Unknown Horizontal Vertical Rectangular Construction: Bare Steel Cathodically Protected (Check one: A. Galvanic or B. Impressed Current) Date Installed: _______________ Coated Steel Concrete encased steel Stainless steel Other __________________________ Double-Bottom Double-Wall Lined inside; Date lining installed: _______________ Spill control: Earthen Dike Steel Dike Concrete None Other _______________________ CRDM: yes no If yes, type: Release Prevention Barrier Elevated tank Double bottom tank Double wall tank CE-AST other ______________ Tank elevated on supports yes no Support material: steel concrete other _________________________ Release Prevention Barrier: yes no If yes, Date Installed: ________________ If yes, Type: concrete synthetic liner clay liner steel other _________ AST Category: Category 1 Category 2 Category 3 OWNER’S TANK ID OTHER ID INITIAL SERVICE DATE Manufacturer: Contents: Construction Date: Last Repair/Reconstruction Date: Dimensions: Capacity: Last Change of Product Date: Design: UL ______________ SwRI ______________ API ______________ Other ______________ Unknown Horizontal Vertical Rectangular Construction: Bare Steel Cathodically Protected (Check one: A. Galvanic or B. Impressed Current) Date Installed: _______________ Coated Steel Concrete encased steel Stainless steel Other __________________________ Double-Bottom Double-Wall Lined inside; Date lining installed: _______________ Spill control: Earthen Dike Steel Dike Concrete None Other _______________________ CRDM: yes no If yes, type: Release Prevention Barrier Elevated tank Double bottom tank Double wall tank CE-AST other ______________ Tank elevated on supports yes no Support material: steel concrete other _________________________ Release Prevention Barrier: yes no If yes, Date Installed: ________________ If yes, Type: concrete synthetic liner clay liner steel other _________ AST Category: Category 1 Category 2 Category 3