Aboveground storage tank requirements

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Preparer of application contact: Last name: First name: Address: City: State: Zip code: Email: Telephone Number: II. Current Permit (Existing facilities only) AST Permit number: Date of issuance or most recent modification: Expiration date: III. Tank Owner/Operator List any legal entity that is an owner or operator as defined in Minn. R. 7151.1200, subp. 24 and 26, of any tank at the facility. If there are multiple owners and/or operators,designate each as(Owner)or(Operator). Cor orate name Mailin address Re istered a ent name IV. Facility Facility name: Address: City or township: County: GPS identifier: V. Description of Business Activities Provide a brief description of the nature of the business activities at the facility and how aboveground liquid storage is used in the course of the business activities: VI. Tanks Using the tables below, provide the applicable information regarding tanks at the facility. In Part A., list all regulated AST systems at the facility. Part B requests the applicant to list certain AST's that are not regulated, for purposes of verifying their exclusion from regulation. For questions about whether or not a tank should be listed, consult an AST permit manager by calling 651-297-8305. A. Regulated Tanks List all AST systems located at the facility that are being used to store any substance as defined in Minn. R. 7001.4205, and that are not excluded AST systems under Minn. R. 7151.1300. For each tank, identify: Tank number: If the facility has a permit, use the company's numbering system from the current permit. If there is no current permit, provide a numbering system. Each tank must have a unique number. Tank numbers must be keyed to the facility layout and to the secondary containment and substance transfer sections of the application. Substance: Identify the stored liquid substance with as much specificity as possible. For petroleum products, food products, and chemicals, identify grade, type, or solutions. If the tank is used to store different substances at different times, list all. If the substance is a mixture, a solution, or has identifiable contaminants, list all components of the substance,with percentages. Capacity: Design capacity to overflow(in gallons) Year of installation • If uncertain, give estimate and identify as an estimate • If the floor of a steel field-erected tank has been replaced, give most recent year as follows: [new floor vear] Status t-a3-25 4/4/07 Page 2 of 8