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.�. �. <br /> im,max-noNcs FOR C'OMPIJOTNN(-; FORM 'B' <br /> GEN11RALINNFRUMION , <br /> 1. One F01ty4 ',I3„ shad be completed for each tank for all N&.: PI:; IN, 'FMIAM C HA 1C E-S, EMOVA S turd/ot any. <br /> otherTANK INFO 1MA`ON CHANGE- <br /> 1 This form should be completed by either the. iv1; T APPL,ICAN''P or the LOC:A1..AGENCY UNDERGROUND TANK <br /> tN"IPEC:IDR. <br /> 3. Please type or print cleanly all requested information, <br /> 4. Use a hard point writing instrument,you are making 3 copies. <br /> `row op PC m:'MARK ONLY ONI, rIVM* <br /> � <br /> Al attt ltc #ta s ,tw., ,c a:€:. ,...r, i;ta dc. s, cs tr_ .4,.::>ti ttte foo tieio g c«n=isle:trc1. <br /> 1 Iatd,c„-ste tfv: &3.i3A or#.:...it the �<ar..k is itssiaalie(i <br /> TANR C OMPL i`IV ALL II' Cay IF NKNO N«;- TI:3lF <br /> A. Indicate owners tank 11) # -If there i>a tank number that is, by the,owner to identify the tank(ex. AB7€}789). <br /> 13. Indicate the name of the company tha r��nufactured the tank ACi1 E"1ANK MFG). <br /> C. Indicate Vac.year the tank was installed x. 1.987) <br /> DIndicate tit(, tank capacity in gallons(cx M)or 10,M)06.): . <br /> IL 'I.ANIC C..ditv7'J"['MS <br /> A. 1. If MOTOR VEHIC,I:E:i.FUF'.L,check bora"1 and complete items B&C. <br /> 2.If not MOTOR V11,111CLE FUEL, cheek the appropriatc box in section A.and complete items B&D. <br /> 13. Check the appropriate box. <br /> C. Check the ap `e of OTO G 1 11IC"I 1 FIX1,(if box 1 is checked in A). <br /> 1). Print the chemical name of the,hazardous substance stored in the tank and the C.A.S. . (Chemical Abstract Service <br /> number), ifbox 1 is NOT checked in A. <br /> III. TANK CONSETitJMION-MARK ONT, rIUM,ONLY IN BOX A, 11,C&I) <br /> 1. Check con1v one item in TYPI.-.OP SYST11.1t,TANKA'1:T'RIAI,,INTF IOR LINING and CORROSION 1'I2OTI'(71I0N, <br /> Z. If 01'I1t ft, print in the space provided, <br /> IV. PIPING INFORNIMION <br /> 1. Circle A if above ground; circle L7 if underground; and circle both if applicable. <br /> 2. If UNKN«kLNy��y,,c€ga+rcle; or if OTFIFR,print in space:pprovided,3. Indicate. the LEAK I)1, E('310 sy ts:;ra(s) used to comply with the monitoring requirement"for the piping. <br /> V. TANK I.EAK DMIX-110N <br /> L Indicate the LEAK M."'I t°C"ITON system(s) used to comply vrith the monitoringrequirements for the tank. <br /> 1. F-MItwtr= ITI)DATE' LAST USM) MONI"11/yEAII (January, 1988 or(A/tlit). <br /> 2. F? <br />