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New Site Onboarding Equipment Survey <br /> Site Number / Address oT,� <br /> c <br /> Date 4� Contractor/Tech Name <br /> 3$ _AirIRR <br /> �'ae7. 7 Y� <br /> r'3.tast ^a'�`_'� L rT � L � Nenufacttaiaf U"MM �IiIM2 �s i�ri'�11i"I'lTvMY 'F� <br /> R=Regular <br /> What type of impact barrier is <br /> M=Mid Grade If gesdine,wt10e in Nominal Galbns porn b this a spirt/ <br /> Nearest(000) (leave blank for UST&) <br /> Order P=Premium ethanol percentage compartmental Write in the lank <br /> Write in the year the UST=Underground B=Bogards <br /> per tank D-Diesel (is E0,E10,E85) List the tank manufacturer tank diameter <br /> (nearest tenth for tank was rtrstaEed AST=Aboveground F=Fe Service <br /> monitor W=Waste Oct If diesel.rate If it is (in inches) <br /> H-Heating OR btodissel tanks leas than I=Inside Service Bays Yes or No <br /> Other(specify) 500 gallons) L=Located away from tral' <br /> fic <br /> N=AST present,no barrier <br /> 2 f' �U ia,occ- - (//,/.� l�s/" Nd C?2 Oct <br /> Al <br /> 3 All) 1 60 <br /> 4 sP . <br /> 5 .AUL : Lu <br /> 6 INVIR r . <br /> Ttptics <br /> Kr�� <br /> VW �al.rI o kconsb� corrosion P. bft.A T. Lhr� , Space f Motod A-MWy time <br /> =���� If the tank Is steel, B=Brine <br /> F <br /> Order S=Steei IC=Impressed Curren! <br /> does have internal D a Dry Matifoided/Siphoned Tank b the an ausiGary Does the tank <br /> per�nk ST=STiP SW=Single wall SAC=Sac Anode fining VC-Vacuum (slave)tank? have manways7 <br /> monitor C Steel w/fiberglass coating D W-Double wall NM=Non�rretaQic Yes or No VL=Vaufled (If so,to what other tank <br /> UNK=Unknown FW4=Fiberglass N=None Yes or NO Ves or tVo <br /> UNK=Unknown UNK=Unknown <br /> t tiA YES A/o <br /> r YES <br /> AIA <br /> YES O} <br /> 3 (fir yl /J/ 1 <br /> YES NO <br /> 4 <br /> YES NO <br /> 5 <br /> YES NO <br /> 6 <br /> ::a/ `. - n' tPatro(etun,BTmk; VW`s'�•+si;?ii3r..��'a` <br /> �'[ /XJ u v i ? s 9i^ <br /> .. >�MaterieldC—&'-& , k ^:xy aX l i" .AW' -tfk i <br /> Rigid: Red =Ameron LCX:OR <br /> Does the remote fill Does product leave the tank Vsu the <br /> Does this tank TSA=Tank Striker Plate F=Fiberglass Ameron sae over size NM=Nan-metafTic <br /> Order have a remote have a spy DSP=DropTube Strike S=Steel Tan/Green=Smith use of a Siphon Bar&are Ne IC=Impressed <br /> per tank fill? bucket? Plate(cage) FB=Flexible SW=Single wan connacfions b each tank vsible? Current <br /> DW=Double wag SV=Siphon&Visible <br /> N=None SR=Semi Rigid Flerc Groan=F�wcon SAC=Sac Anode <br /> monlhrr <br /> Yes or No Yes or No UNK=Unkmwn UNK=Unknown Blue=OPW SNV=Siphon but not v&ble UNK=Unknown <br /> NA=No remote WhitdYefiow/Blue=TC! NA a Not dispensed by siphon <br /> Z Al,� v1/ T -�w A61 <br /> 3 lVd �� / �J �-5 MtTvk <br /> 4 <br /> 5 <br /> 6 <br /> issued 12/27/2017 Page 1 of 10 <br />