COMPLIANCE INFO_1986-1997 - Laserfiche WebLink

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GENERAL IN,`;pRUCF1ON& L One FOR "B"shall be completed for each tank fors all NEW PERE s,Pi:,2, rr CIA GF.,S, 10EMOVAUS head/or an other IANK I FORMA11O (11ANGId. 2. This form should be completed by either the I" . L I"APP1,;CAhrr or the LOCAL AC3ENC'Y UNDERGROUND' IANK I: SPE C1"C)1. 3. Please type or print clearly all requested information. 4. Use a hard point writing instrument,you arc making:3 copies, OP OF FORM-'MARK ONLY C EI "I'.":; " 1. ark an (X) in the box next to the nem that best describes,tae reason the form is being cotillpleted. 2. Indicate,the DBA cat, Facility name where the tank is instaiied, I. IANK DF-SC RIVIIC) -.0 OMPI-ExH ALI,F `E: S-IF UNKNOWN-SC);ET'FWII A. Indicate:ownem tank 11) # -If there is a tank number that is used by the owner to identify the tank(ex.A1370789). B. Indicate the name of the;company that manufactured the tank(ex,ACME 1ANK MFG.), C;. Indicate the year the tank was inskalled (ex. 1987). 1). Indicate the tank capacity in gallons(ex.7-5,0W or 10,000 etc): 11. 1`ANK A. 1_ If Ai0:31'OR VEHICLE FUEL,check box F and coreplete herlts 13 & C. 1 If not N-10'If) VE1111C:LE FulI.,deck the npprc.praiate box in section A and complete items 13& D, B. Check the appropriate box. C. Check the type of MC1'FORVEHICLE',FUEL L(if box I is checked in A). D. Print the chemical name of the hazardous substance stored in the; tank and the C.A.S.#.(Chemical Abstract Service number),if box 1 is Nf: r checked in At I11. '1"AI DCT swiltF crfo)td-mmm t mw ,m1m ONLY IN BoX A,13,C&11 L Check only one hem in'INTIF CP SA S I`J?AA,'IANK Mzi'1`.I.EIAL, INTERIOR LINING and CORROSION BION I"IZO IT,C,1'I0N, 2, If 0111FA, print in the spare provided. IV. PIPINGS INFORMSHON 1. Circle A if arrow=s;ground; circle If if underground;and circle both if applicable: 2. If UNKNOWN,circle; or if 011 TER,paint in space prov>idcd. 3. Indicate the;LEAK 1tI.SI;('110N systena(s) used to comply with the n-ionitoring requirement for the piping V. 'IANK IJAK I)FI1'I-lC'I.10Pi 1. Indicate the LF.A used to comply with the monitoring requirements for the tank. VL. INC-Y) dA`I7t3Z3 ON IANK.PERMANEN11Y C.LOSI:TD IN P AC:EC L ES:['liv[AI`F:i1) I)A'I'I;