|
_ w
<br /> ri>i> I,.4.I ha?, E, completed ;<> each tank ,r:ail i "i ,11 fRMIT ,'TIAN F S, � :°any
<br /> I bis R , shoWd be temTkWd, by either the ERMIT A L"IL C'For the LO(:AI.A(;I,,N Y iJNDERGR UND TAN
<br /> 5 Phase inn or pow 6iC.Q all requested infornmtlon,
<br /> 4. the a hud (Saint writing instrtrattent, you are making 3 copies.
<br /> . ,ink , q) in the Nn rgai'.o the Mat that best describes the renson the III) t is bring compl tdcL '-
<br /> 1 In".e.i.,<L, a.., DBA .,ir 1«,,sax€ nano:w4i"e ii74' A?'rk __ :ns:ai=eta.
<br /> L 1ANK t:i r RIF ; N-C-,'0MP,F"U:t.Aid,Ilr:ihi;5-IF(7.sI?ri.(,° N-S-0 I'I,(.II
<br /> , l r(hcai. -,vrac s ta,aT ID 0. ii Out, 0 a tank number that is used by the crumer to identify the tank(ex,ABMMn
<br /> It i;rrWeat " Te nmracif the company Am manu;factcrmd tie ?risk(sx_A('iiii;`1`AN ;4II~G.).
<br /> (I Ind a rte the year he WE mw insra hed Qv 1987),
<br /> 11 Indicate the tank-capachy in gr„allvens(ex.25,000 or'I£},tI(>(i etc,),
<br /> A. I, If NVAUR V I(l(ISE' $'Be,a,a... OYA box 1 and c"or2plete t?;°Gnts II sit C.,
<br /> t, ,, a=: . MOTOR VI ifi";&,I;. ",t,r„I,,, chock the xappr.oprittqe box in section A"R and complete items((& I3,
<br /> Ti- u V,:,,a ,or,,,riaa hoe,
<br /> (I Check tho qpc of 1401UR Q11TWET t'_ °;r,ir:buss "I is checked in P0,
<br /> 11 Feuer t,.W chc rnVal name cd Me haan&w.An a?rf e stored in the frank and the (,..A.S,#.(C;hernical Abstract Set-vice
<br /> naeva l (No i s .+'9 i aeckad it A.
<br /> IIi. 71aNK(.:GNSI'I :. F7110 ...MARK 00,41',i i a.i(iAIIAY IN BOX A,it,C&I)
<br /> 1. Chmk ray one.,:;a,,.in ]Pf. (_ g.�7 ,A.., e_'?, < ,'e M/Vl!:. IAI., ITITIVIOR T..lNING and C.'ORROSION f'I$( TEtC IION
<br /> IV, PI:i'I"n(: ININKA4AIJOEN
<br /> a. Code A s above (i if r id' rjrrwuari; and circle both if a'pplicAN,
<br /> s_ haalkatz Ae JEAK I N INANN . ,ar,.a) uxed to coetitly with the nuenicaring requirement for the piping.
<br /> t. Lwow ler. LEAK K ,)1..._C.'ION .;ssara(s)rased to d ,rnply-as°ith the monitoring requirements for the tanL
<br /> VI, Iiiira.aill Arsi10N t"IN TANK I'I"1RINC aNI NHA ((.s,.SED IN
<br /> 3I'LAC E �y
<br /> 2, ITRIM A.FUD { ? AN irkT of HAZARDOUS SLl,3;°FATs(J rmnaofing in the tank (in (Gallons),
<br /> :I., WAS 1ANK;fl 11) Will l.st AI' #,at!TIAIN (heck" "Y as'or"N(i',
<br /> APPLICAbn:Ts usi r",:N DM)IyXIIF I"II€ IK)RlA AS Nissl AJI°I',ii.
<br /> INSIT!A-'FION FOR":VIII I IIC:AL AGENt,"111ES
<br /> The state st tra tank i lcrifification number is composed of the two digit county number, the three digit jurisdiction
<br /> >.am e3 the "r:QR fulky nunyhet and the ..y digh vmk n AAnber, `Iiae county and jurisdiction numbers are predeterarti sed and
<br /> can he NEN , .-I:t CaNsfy the y1we l rd a,,°,A�F. ._.. The facility number must be the wane as shown in form'A', TEae
<br /> g nk num1wr voy bc mYgma by tl, _veal ,.a awy; however, sbis tiaamber must be numerical and cannot contain an alphabet, If
<br /> the local agony,i >krs the me; I ,r,x t to aveign the Runk nuT11to ,I3icam leave h Wank-,
<br /> I',I'is wIR (:Ivriil7„,00'II.,A ( Tl T( 'II "I S'I?(ii 'I7 l( i (miry TO VIUUII'T[UI
<br /> y(.X.,,'UR (.,'`F'I"iii;INi'(tYVAP- a`ICr.11i, THE 110C`A3,:GEN,(" IS RESPONSIBLE irOi2.1111(.1,OMP111110N()F111I(
<br /> "'I,(XAL A .,:Ilrll,Y USE(.INLY'IINI'(IIi.Ysi/0 SON TK)X AND I1)It 1N)RVh%RJXN1G ONE 17O 'A7 AND ASSO(,INIED
<br /> FORMI „`i I a IIIA IA()i.,i.(I yI I(I AM I TIII�E&S,.
<br /> FIAl'I Tyle(:AJ Ii'(II(SI
<br /> a ,a a III WS I'I(ii Ri.S(iIURC i:wi3(.`CIiI I` .(I,BOARD
<br /> CIA aw ( a
<br /> PROC° G( as=
<br /> P x), TI(,SX 527
<br />
|