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S�-1� FOLLOWING INFORM �T N MUST 3E PR��VlDED FOR MPCA USE, <br /> i n�rrrarzy Cax��t,d��� ��a,K�c rA2; <br /> Leak Detectlon Mefhod: Tanks�i�;G,S�pr, Pipi g tSrDl^and � <br /> • -r�5n�b T�sn�C, <br /> Spl!! Preventton (Contalnment BaslnJ: Yes No <br /> Ove�ll Protectlon: Type OPbJ ��SO <br /> Depth to Ground Water: nA <br /> Anchor/ng: Required Not Required ✓ � <br /> Type of Backflll: �n� <br /> All plans submitted must show at least the followi�g infoRnation o� plot plan. Give measure- <br /> ments from tanks and di ensers to� ro e lines buildi s drivewa and surface waters. <br /> YES N/� YES N/A <br /> (� ( ) Propercy Linea (�( ( ) Venc Plpa Terminacion Type <br /> ( rJ' ( ) Bul•ldlnq(s) � (..�' ( ) VenC Plpe Slza <br /> ( �Y ( ) 'Cank Slze ( -� ( 1 Pipinq Wyouc <br /> (� ( 1 Producc in Tank (•�Y ( ) [,oca�ion o[ Dispenaers � <br /> (✓f ( 1 Tank Bucy Oepch ( ) (-�WaCecvays <br /> (�f ( 1 Concr�ce Thicknesa Over Tank (N' f ) Oispenser Proceccion <br /> (�'/ (� 1 Tank FL11 Openlnq (..Y ( ) Siqna: No S�okinq-Shuc OtC Hotoc <br /> (�,r ( _) Drivevays Hlnimum aqe toc SalC Serv� - <br /> 16 Years Old <br /> (�/ ( ) E�erqency Concrols („✓ ( ) 20bc Hin. Flre Occlnquisher <br /> ( �! ( ) Leak DececCion {�/ ( ) Sei[ Serve ACCendanc Loca�lon <br /> (''� ( 1 Over�lll Pro�ecclon (-� ( ) Tank Locacion and Clearances <br /> (�' ( ) 5�111 Prevencion (-'/ ( 1 eacklLll type <br /> ( 1 (� �nchorinq <br /> Remar s: <br /> NOTSCE: ONE COPY 1�TST BE PRESENT AT SITE FOR REVIEW, <br /> OPPZCE USE ONLY IIGPL.aN <br /> Review Stamp Area Stamp In .�,rea <br /> __.._ ����� 'Y'Y �� � <br /> s ,�JBJECT TO F1NAL INSPECTlON <br /> AND ANY CHANGES NOTED. <br /> � CONTACT LOCAL FIRE AUTHORITr . <br /> ?RIOR TO PROJECT STP�R�. �rocess compLeced-oace �ailed ouc <br /> M�, iV�50TA S AT FIRE MARSHAL <br /> gy: :41sce11aneous In�orma�ion <br /> Date: — � L�' � <br />