COMPLIANCE INFO_1985-1998 - Laserfiche WebLink

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GtWi KAL INSIRut Imis. L One I'°C")RM'I„shall be completed for each tank for all NM PFRWN1 HI wr( CF-Sy R132VIOVATS and/or any other`FA IC I€ ``ON€"PIAN€s 2. This fornt should lie completed ted try either the PERMri APPLICANr or the LOCAL AGF-NCY9 ISRGEZOIJND TAN IISP^ . }FC ;i. Please type of printclearly all requested information, 4. Use a"hard point writing instr nue nt,you are making 3 copies. TOP OF FORM, 'MARK ONLY ONE rulm, �:L Mark an )1n the box next to the item that best describes the reason the£`oars is,being completed. 2. Indicate the DBA or hacflity A,an,,c where the tank is snstalled. I. TANK DE- RIP1 SO -(X) I`11I 1I,AIL f'f S�IS-III UNKNOWN-SO SPECIFY A. Indicate owners tank 11:) #®If there is a trick number that is used by the owner to Identify the tank(ex.AB70789). T3. Indicate the name.of.the company that manufactured the lank(ex.AC: F 1AN MFG). C; Indicate the year the, tank was installed(ex. 1987), I). Indicate the,yank capac€€y in paflons(ex. `5,0(k or 10,E etc.). H. TANK€rBINTE I i A. 1. If MOTOR VFlIIC"L.I, check box 1 end complete heens_I3 R C. y If not :'00 OR VEIHI CI,p Id.s:I,,check the appropriate box in section A and complete items I3& D: 13. Check the appropriate box. C. Check the t pe of MOTOR VEHICLE I,FI'r L,(if box t is checked in A). 1,). Print the chemical, name of the nzwdoes substance stored in the tankand,the C.A.S.#.(Chemical Abstract Service ngrinber),if box 1 is-N 'h checked in A, 1TI. TANK CON91 UC I£:N- ARK€NE"OTW OMIX IN BO f4,11,€: 1. Cheek only eine item in TYPE 01 1YS`'I°W1:ANK Iv NIT"RIAL, IN`fFRIOR LINING and CORROSION PRO`I'I:CTI'I0N. 1€ OTHER,print in[b space provided, IV. I"IPIhTCI Ii I R AT CIt 1, Circle A if above ground;circle U if uncle „round„ and circle both if applicable. 2. If UNKNOWN, circlef iI 0TII 11 print in space provided. .3. Indicate.the LEt'c used to comply with the monitoring requirement for the;piping. V. TANK 11"K.DENTICHON L Indicate the 1.,1;x) DI-I I;