X hits on this document

53 views

0 shares

0 downloads

0 comments

3 / 24

Section 2: Tank System Information

__

Fill out the tank number for each tank but only use the MDE Tank ID numbering system. Use ( ) box if information is

obtained from facility registration form. Tank and Piping (MDE ID#)

()

Tank #

Tank #

Tank #

Tank #

Tank #

Owner Tank ID # (if different) Status (I-in use or T-temp. out of use) Date of Installation (month/year)

Capacity (gallons) Product (see Chart A below for code and list each compartment tank product separately) Tank Construction Material (see Chart B for code) Compartment Tank (Yes/No) (If Yes, list capacity of each compartment separately) Double-Wall Tank (Yes/No) Piping Type (SS) safe suction; (US) U.S. suction (G) gravity; (P) pressure Piping Construction Material (see Chart C for code) Double-Wall Piping (Yes/No) Outer Wall Pipe Construct. Material (see Chart C for code) Emergency Power Generator UST (Yes/No) Global Position Signal – Only one set of coordinates is to be collected while standing over the center of each tank field. Latitude: Tank Field #1 Longitude:

Tank Field #2

Latitude:

Longitude:

Tank Field #3

Latitude:

Longitude:

List tank MDE ID # for each tank field according to MDE Registration Form.

Section 2: Tank System Information continued on Page 4

CHART A

CHART B

CHART C

CODE PRODUCT DESCRIPTION

CODE TANK MATERIAL DESCRIPTION

CODE PIPING MATERIAL DESCRIPTION

1 2 2a 2b 3 4 5 5a 5b 5c 6 7 8 9 10

E-10 E-85 Diesel Gasohol Ethanol Methanol Gasoline Hazardous Substance Heating Oil # 2 Heating Oil # 4 Heating Oil # 5 Heating Oil # 6 Kerosene Mixture Used Oil Car Wash O/W Separator UST Other (Must Describe)

1

Asphalt Coated or Bare Steel

2

Cathodically Protected Steel

3

Composite (Steel w/FRP)

4

Concrete

5

Epoxy Coated Steel

6

Fiberglass Reinforced Plastic (FRP)

7

Polyethylene Tank Jacket

8

Other (Must Describe)

1

Bare Steel

2

Galvanized Steel

3

Fiberglass Reinforced Plastic (FRP)

4

Copper

4a

Copper-slvd. in PVC, FRP or Plastic

5

Flexible Plastic

6

No Piping

7

Other (Must Describe)

Form Number: MDE/WAS/COM.055 Date: April 3, 2007 TTY Users: 800-735-2258

Facility I.D.

______________________

Page 3 of 24 Recycled Paper

Document info
Document views53
Page views53
Page last viewedWed Dec 07 10:45:56 UTC 2016
Pages24
Paragraphs1161
Words17459

Comments