Laserfiche WebLink
B. Tank Information <br />l . Tank number <br />See Guidance — page 4 001 <br />2. Capacity Gallons: 20,000 <br />002 <br />3. Stored substance Type: Gasoline, E10 <br />See Guidance — page 4 Specify: <br />4. Compartmental tank only <br />See Guidance — page 4 <br />Compartment 1 Gallons: <br />Type: <br />Specify: <br />Compartment 2 Gallons: <br />Type: <br />Specify: <br />Compartment 3 Gallons: <br />Type: <br />Specify: <br />5. Special use (check either or El Heating <br />both if applicable) ❑ Generator fuel <br />6. Tank type Type: Figerglass,DW <br />See Guidance — page 4 Specify: <br />7. Tank corrosion protection <br />See Guidance — page 4 <br />8. Fill pipe spill containment <br />(spill bucket) ❑ Yes ❑ No <br />9. Overfill prevention type <br />See Guidance — page 4 <br />10. Stage 1 vapor recovery for <br />gasoline tanks <br />11. Primary method of tank <br />release detection <br />See Guidance — (rage 4 <br />Gallons: 10,000 <br />Type: Gasoline, E10 <br />Specify: <br />003 <br />Gallons: 10,000 <br />Type: Gasoline, E10 <br />Specify- <br />004 <br />Gallons: 10,000 <br />Type: Diesel, Petroleum <br />Specify.: <br />Gallons: Gallons: Gallons: <br />Type: Type: Type: <br />Specify: Specify: .`Spex:ify <br />Gallons: Gallons: Gallons: <br />Type: Type: Type: <br />Specify: Specify: Specify: <br />Gallons: Gallons: Gallons <br />Type: Type: Type: <br />Specify: Specify: Specify: <br />El Heating ❑ Heating El Heating <br />❑ Generator fuel _ 0 Generator fuel 0 Generator fuel <br />Type: Figerglass,DW Type: Figerglass,DW Type: Figerglass,DW <br />Specify Specify SpecrIy <br />Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />C. Piping, Pump, and Dispenser Information: <br />1. Tank number <br />See Guidance — page 4 <br />2. Piping type <br />See Guidance — page 4 <br />3. Piping corrosion protection <br />See Guidance — page 4 <br />4. Primary method of piping <br />release detection <br />See Guidance — page 4 <br />5. Dispensing type <br />See Guidance — page 4 <br />6. Submersible pump <br />containment <br />See Guidance — page 4 <br />7. How many dispensers <br />serve this tank? <br />8. Dispenser containment <br />See Guidance — page 4 <br />Comments: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑Yes Li No El Yes No <br />001 002 003 004 <br />Type: Type: Type: Type: <br />Flex nonmetallic,DW Flex nonmetallic,DW Flex nonmetallic,DW Flex nonmetallic,DW <br />Specify: Specify: Spe::rfy ; i,r2cify. <br />Type: Type: <br />Specify: Specify: <br />Type: Type: <br />SINPCXY: <br />Type: Type: Type ' Type: <br />Specify_ _ Specify: 1 Specify. Spec+.fy <br />www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats <br />t-u5-04 • 6/21 / 13 Page 2 of 5 <br />