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THE FOLLOWING INFORMATION MUST BE PROVIDE1 FOR MPCA USE. <br /> Leak Detection Method: Tanks visual Piping N/A and <br /> Spill Prevention (Containment Basin): Yes X No <br /> Overfill Protection: Type Extractor Vent <br /> Material Under Tank: Concrete <br /> All plans submitted must show at least the following information on plot plan. Give measure- <br /> ments from tanks and dispensers to: property lines buildings_, driveways and surface waters. <br /> YES N/A YES N/A <br /> (X) ( ) Property Lines (X) ( ) Vent Pipe Termination Type <br /> (X( ( ) Building(s) (X) ( ) Vent Pipe Size <br /> (X) ( ) Tank Size (Gals.) ( ) (X) Piping Layout <br /> (X; ( ) Product in Tank ( ) (X) Location of Dispensers <br /> (X) ( ) Tank Dimensions ( ) (X) Waterways <br /> ( ) (x) Dike Dimensions ( ) (X) Dispenser Protection <br /> (X) ( ) Tank Fill Opening (X) ( ) Signs: No Smoking-Shut Off Motor <br /> (X; l 1 Driveways Minimum Age for Self Serve - <br /> (X l 1 Lightning Protection 16 Years Old <br /> Emergency Controls (X) ( ) Fire Extinguisher <br /> ( : (X) Loading Rack ( ) (X) Self Serve Attendant Location <br /> (X l 1 Overfill Protection (X) ( ) Tank Location and Clearances <br /> (X; ( ) Spill Prevention ( ) (X) Piping Protection <br /> (),(i ( ) Material Under Tank ( ) (X) Tank Spacing (sholl to shell) <br /> Remarks: <br /> NOTICE: ONE COPY MUST BE PRESENT AT SITE FOR REVIEW. <br /> OFFICE USE ONLY AOPLAN <br /> Review Stamp Area Stamp In Area <br /> 1';1 <br /> REVIEWED <br /> • SUBJECT TO FINAL NOTED <br /> AND ANY CHANGES .ON <br /> I • CONTACT LOCAL FIRE AUTHORITY <br /> • •10- TO Pi •JECT START• Process Completed-Date Mailed Out <br /> tM NN `,� ST IRE -ARSHAL <br /> VI <br /> By: Miscellaneous Information <br /> Date: <br />