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r , <br /> IN, U("ITONS FOR(,'OMPI TMN(I IN111r <br /> GENERAL IN IRIaI'IYIYNSa <br /> 1. One IrC3RNI"B'shalt he completed for each tank for all NERMTI' 1ANGUS„ RFMOVAIS and/or any <br /> other'17ANI(Ifi� 3 I'IO 1 ILAN <br /> 2. This Fortaz should be com9plcied by,either the PERmrr APPLICANTor the I L AGPNCY U T?RCIIB.CIT )TANK <br /> 1NSI1l r(1I)0R <br /> 3, Please type or print clearly all requested information, <br /> n, <br /> 4. 1 Use a hard point wrttaatg instrument,vitas are making 3 copies. <br /> TOP OF FORM:'MARK ONLY ONE rIEM' <br /> I. Mark an (°C)in the bras sleet to the heat that best describes the reason the form isbeing completcdT <br /> 2. Indicate the l BA or I'at rlaty narce where the tank is installed, <br /> I. TA K I31�SC RIVI°ION--(X)MP►,I ll" AI,L I°Ii S-Ile I.JN CI N-SO S"' -"[lam <br /> A, Indicate owners tank 11) # -If there i; a tank number that is used by the owner to identify the tank(ex.AI370789). <br /> 3. Indicate the name of the company that manufactured the tank(ex.ACME TAMC'.tTF6,). <br /> C. Indicate'the year the tank ams fits mlcd (.x. lai87). <br /> 13. Indicate the tank capacity in gallon,(ex,25,000 or 10,OW etc.). <br /> H. TANK CONIEN IN <br /> A. , If I CI"f`r VEHICLE,1,FOP,L,check k ox I and complete items I3�&C. <br /> ?, rt not d�Ii"MTOR i"Ifls LE,I . 1,check the appropriate box in section A and complete items B cC D. <br /> & Check the appropriate box. <br /> C. Check tete type of MOTOR VEEIC 1 E t Ci I (il''3ox 1 is checked in A). <br /> I3. Pram the chemical,name of the mizardous substance stored in the tank and the C rk:S:#.(Chemical Abstract Service <br /> number), if box 1 is NOT checked in A, <br /> IIT. TANK CONSTRUCI10 -MARK CINE rlIN ONLY IN it A,B,Ca&IY <br /> L Check oniv one: hent €n°I YP 01'SYSTEM,TAMC MATERIAL, INTERIOR LINING and.CORROSION I RO—FI C710N. , <br /> 2. If OTHEIIA,print in'the space provided, <br /> IV. PIPING INF'ORMN110N <br /> 1. Circle A if above ground,; circle',!if underground; and circle both if applicable. <br /> 2. It UNKNOWN cis t : or rt OTHE.R.print in space provided, <br /> , Indicate the 1,13,NIC 1.1i''',TEC9IO sysic nts3 used to comply with the mopito,ring requirement for the piping. <br /> V. TANK LTAK DII°IEC:110N <br /> 1. Indicate the 1,14-A D Th;(:I"ON system(s) used to comply with the monitoring requirements for the tank. <br /> Ie INliORNA711ON CSI YTA K PERMANIINIIX C;I�t�.SED IN ISI CF <br /> 1. F;S 'IM,,1FFID DxV I I; <br />