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t` <br />I ®1RUC nO S FOR C OMP1,17I 5 [I)RMB' 0 <br />GEMIRAL N,` I" C3 'ION Sr <br />1. One FORM "I3" shall be completed for each tank for all NEW PERMYMS, I FRIvIEI' CSI GES, RMWOVAUS and/or any <br />otherTANK I TIO CHANGE. <br />2, This form should be completed by either the PERMIT PP "I' or the LOCAL AGENCY UNDERGROUND TANK <br />INSPEC170R. <br />3, Please type or print clearly all requested information. <br />4. Use a hard paint writing; instrument, you are making 3 copies. <br />TOP 017 FORM. <br />"MARK ONLY ONE 1: <br />1. Mark an (X) ars the box next to the item that best describes the reason the form is being completed. <br />2. Indicate the DBA or Facility name where the tank is installed, <br />1. TANK DES MP`1TON - COMPIZIL4 A1.1, rIMMS - W UNKNOWN - SO SPECIFY <br />A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex; rS870789). <br />B. Indicate the name of the company that manufactured the tank (ex, ACME TANK MFG.). <br />C. Indicate the year the tank was installed (ex. 1e987). <br />13. Indicate: the tank capacity in gallons (ex. 25;6 or 10,(M etc,). <br />H. TANK CONFEMPS <br />A. 1. If MOTOR VEHIC;I;I:? <br />