阿拉斯加州的（ stateof alaska）.docVIP

Alaska Department of Environmental Conservation Underground Storage Tank Operations Inspection Report 2010 Instructions: Only a person currently licensed by the State of Alaska in UST Inspection may fill out this form. Detailed instructions are in the ADEC UST Operations Inspector Reference Handbook, available at ADEC or online at these links: http://www.dec.state.ak.us/spar/ipp/docs/manual1.pdf and http://www.dec.state.ak.us/spar/ipp/docs/manual2.pdf Section 1: General Information Facility Name: Owner Name: Location Address: Mailing Address: City: City, State, Zip: Phone: Phone: Fax: Operator Name: Mailing Address for Compliance Tag Decals: Phone: Name: Fax: Address: E-mail: City, State, Zip: ADEC Facility Number Inspection Date UST Inspector License # UST Inspector Name All applicable tanks are registered? Current Compliance Tag is visible to fuel distributor? (Yes (No (Yes ( No Print out the ADEC Facility Tank Summary from the web database if corrections are necessary. Highlight and make corrections to tank information and attach. Use the ADEC Tank number system on the first line. Please number compartmented tanks, for example, as “1A” and “1B,”and inspect each compartment as if it were an individual tank. Tank and Piping (ADEC number) Tank # Tank # Tank # Tank # Owner Tank number, if different Status (Active or Taken-Out-of-Use) Capacity (Volume in Gallons) Product (Specify type of petroleum) Tank Construction Material Compartment Tank (Yes or No) Double-Wall Tank (Yes or No) Piping Type (Suction or Pressurized) Pipe Outer-Wall Construction Material Double–Wall Piping (Yes or No) Multiple Pipe Runs per tank (Yes or No), if Yes, show on map, page 2 Emergency Power Generator (Yes or No) Questions? Contact the ADEC UST office: 907-269-7679 Cheryl.Paige@Alaska.Gov fax:907-269-7687 http://www.dec.state.ak.us/spar/ipp/tanks.htm Return this Original Form, with each