Boxmeer_Notification foR US Tank

- FOfiTANKSIN
STATE USE ONLYl.O. Number
NC
Notificrtion is rcquired by Fcdcnl hw for rll undcqround trnts thtt hrvc bcer
us.d to slor. r.guhlcd substrnc6 since Jrnurry I, 197,1. th.r arr in thc ground t3 of
Mrv t. 19t6. or thrt rrc brought into rse rficr Mry 6. l!1t6. Thc informetion rcqucstcd
is rcquirtd by Scrtion 9002 of rhc Rcsource Conscrvttim rnd Rccovcry Acl.(RCRA),
rs rmcndcd.
The primar.v purposc of this notification program is to locatc and evaluate undcr-
ground tanks that store or have storcd petroleum or hazardous substances. lt is
expccted that the inlormation )'ou provide wiil be ba:;ed on rcasonably ar,ailable
rccords. or. in thc absence ofsuch records. lour knowlcdge. belief. or recollection.
Who Must Norify? Secrion 9002 of RCRA. a5 amended. requircs that. unle;s
exempted. owners o[ undcrground tanks thar storc rrgulated substances must notifv
designated State or local agencies of the existcnce of their tanks. Owner means-(a) in lhe case of an undcrground srorage rank in use on November 8. 1984, or
brought into usc alier that date. an), person who owns an underground storage rank
used for the storagc. use. or dispensing of regulared subsrances. and(ir) in ihe casc of an1' underground sroragc ank in use beforc Norember 8. 1984,
but no longer in usc on that date. any person who owned such unk immediarely bcforc
rhe discontinuation of irs use.
Whrr Trnks Arc lncludcd? Underground storage urnk is defincd as any one orcombination of .tanks that ( I ) is used ro conEin an acormulation of 'regulatcd sub-
stances."and (2) whose volumf(including conncctcd underground piping) is l0% or
more beneath thc ground. Some examplcs arr underground tanks storing: l. gasoline.
used oil. or diesel iuel. and 2. industrial solrents. pesticides. herbicides or fumigants.
Whrt Trnks Arc Ercludcd? Tanks removed from tire ground arc not subjccr to
noiification. Other unks cxcludcd from notificarion arc
l. farm or re;idenrial tanks of l.100 gallons or lcss capacitl'uscd forstoring moror fucl
for noncoomercial purposcs:
2. unks used for storing hearing oil forconsumptir.e use on the premiscs whcrc srored:
3. scpric tanks:
4. pipclinc facilitre; (including gathering ltnes) regulated under rhe Narural (ias
Pipeline Saferl- Act of I96E. or the Hazardour Liquid Pipeline Salet! Acl ol 1979. or
which is an intrastatc prpciine taoiirr'rcgulated undcr.State la*r:
5. surfacc tmpoundmcnts. prts. ponds. or lagoons:
6. storm rlatcr or waste r.rater collection svstems:
7. flow-through proccss tanks:
t.liquid tnps orassociarcd galhering lincs directly relatcd to oil or gas produdion and
Sathcnng operalions:
9. storage unks situated in an underground area (such as a basemcnr. ccllar.
mincworking. drift. shaft. or tunnel) if rhe storagc tank is situated upon or above rhe
surlacc of thc floor.
Whrt Sublirnc6 Arc Covered? Thc notification rcquiremenrs appll ro under-
ground storage tanks that contain regulatcd subsnncBi- Thrs includes anr subsrance
dcfirrd as hazardous in scction l0l (14) of the Comprehensive Environmenral
Rcsponsc. Compcnsation and Liabilit.v Act of 1980(CERCLA). with the cxception ol'
thosc substances regulated as hazardous wastc undcr Subtitle C of RCRA. lt also
includes pctrolcum. e.g.. crude orl or anv fracrion rhcreof which is liquid ar standard
conditions of temperature and prcssure (60 degrce; Fahrcnhcit and 14.7 poundr per
squarc inch absolutc).
lf,hae To Notify? Completed notification lbrms should be sent to the addrsr
givcn at the rop of this page.
Whcn To Notify! l. Owners of underground :itomge tanks in usc or that have bcen
rakcn oua of opcration altcr Januarl l. 1974. but strll in the ground. mux norill b1'
May 8. 1986. 2. Owncrs who bring underground storage tanks into use after Mav il.
1986. must notify wirhin 30 days of bringrng the tanks into use.
hnrlticc Any orncr who knowingly frib to nolify or submir felsc informrtionsh.ll bc srblcct lo. civil pcnrlty not to crcced S10.0fl) for lrch trn& for which
nodllctdon b no( givcn or for thich frlsc inforrrrtirn ir suhnittad.
Please type or print in ink all items except 'signature' in Seaion V. This form mus by completcd for
esch location contsining underground slorrge tsnks. lf more than 5 tanks are owned at this location.
photocopy the reverse side. and staple continualion sheets to this form.
lndicate number of
continuation sheets
arrachd
Owner Name (Corporaoon. lndividua,. Public Agency, o, Other Entily)
STORK SCREENS AI,IERTCA INC.
City State ZIPCcdeCHARLOTgE N.C. 28213
AreaCode PhoneNumber704 598-7].7t
Type ol Owner (fil,t* ril Wt rpp$& )
flcurrent E st t"orlocalcov't tr E.jHT.Lfl ro,,", tr [ffi?l3flf,.r.no. tr 8,[?ffii?i,
(tf samo as Section 1, rnark Oox frere [ ;
Facility Name or Company Site ldentilier, as applicable
STORK SCREENS A.I,IERTCA INC.
Street Addr€ss or State Foad, as applicable3201 N. r-85
City (nearast) State ZIP Co<,eCHARI.OTTE N.C. 282L3
lndicate
nurnberot
ulnksatthis
location
Mark box here if tank(s)
are located on land within
an lndian rBorvetion or
on other lndian trust lends
Narne (ltsameassection l. mark box hereJAI{ RTET
JobTitle
PI.ANT MANAGER
AreaCode
704
Phone Numbsr
s9 8-7L7L
n Mark box hera only it this is an amendd or subsequent notilication lor this location.
I certify under penalty of law that I have personally examined and am familiar with the inlormation submitted in this and all attachod
docum'ents, and that based on my inguiry of those-individuals immediatoly responsible forobtaining the information, I believe that the
submitted information is true, accurate, and complete.
Name ancl otlicial title of owner or ownsr's authorized represontative
JAN RTEF
Tank tdentltlcailon No. (e.g.,ABC-lZt), orArbltrarlly A$lgned Scquenthl Numbcr ( a.9., 1 &3.-l fia*{o.'Sflarato TankNo.'Waste o . TankNo.\1 Tank No.
2 Tank No.
l.SlrelurofTank ....i
(flia* att utr,t epily d ,"r*3'nff8tl :; UfPermanenilyOutof tpse
Brought into Us6after *Yn
Frl Frl \-fir-f
F
rr]
2 Ecllmeted Aqc ffeant 4 4 4 43. Edmaled Totral Caoac{tv (Gellont}1000 550 / 4ooo 5504.MltrdilolConrfiuc{on -. \UI€EI \(*lrrrconca)
concrete
Fibeqlass Reinforced Ptastic
Unknown' Other, Pl€asspoc{fy
rT.I
\l-lE-
rn rx-'r
l-1
5.lnlrmdPrcEcdonOniiuimdw CathodicProtection
ldterior Lining (e.9., epoxy resins)
None
Unknown
Other, PleascSpacify
rxr rn rn rr1Ef
& Exlomd Ptolecdon
(loa* alt ttnt ailplyS' Cathodic Protection) tuinm(e.g.,asphaltic)
Fiberglass Heinforced plastic Coated
None
Unknown
Other, PleaseSpecrfy
t-ll'?-l rra-l rrl
7. Plplngoin*aru",r'rrrrylu *,*rffi:l=l
Fiberglas Reinforced Ptastic
CathodicallyProtected
Unknown
Other, PleasaSpecify
rTI t=-l
& Subrtancr Cunrntlv or Ld Stond*ttffiai;;iili;iffi#"- - : a"Pnv
(k*dtilr,tryf,tig,,i b' fttohunr
Dieel
Kerosane
Gasoline (including atcohot btends)
Used Oil
Other, PleaseSpecify
c. l{E&urSubtlnc.
Please lndicate Nameof Principat CERCTA Substrance
Chemicat Abstract Seryics (CAslotfo.
Mark box Cl if tank stores a mixture of substances
d. Untnown
Oi1,/wate Waste o
Fr-l
r-]
Itr=.El tr=
9. Addltlonal lnlormatlon (torhntr pcmancnflyirkcn out ol cervlce)
8. Estimated dato tast used (molyr)
b. Estimated quantity of substance remaining (gat.)
c. M a rk box tr i f tan k was,i I radJ:: g;ll:t*?,:Ji3j
//
l-]
demr(lromS.cilooll SE^pJ. qCPEEIIS Locettoo(lrorngrctorll CHARLOTTE F,,oNo.2 a 2 pqct
EPA Forin 7f,10-1 (11-8!t) Ferorse ItU.a Oararlrrrn tlnilrl OrtlGa, ttaa..aaa.?tl na,ge2