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- r <br />.a'ltC! 0ep 11 i'i v <br />Gv i I P 0 !9 i' aTn <br />P.Cj. Box 701S <br />7T7ci_i.aviopolisg IN 45E07-701.0 <br />Notification is required by Federal �Iaty for an.,unclergt}ound tatjks tfisO ase Fleerr <br />used to store regulated substances sinfe5art`uary 1, 1074, that are in the ground of <br />May 8,1986, or that are brought into tqe after May 8,1986. The information ed <br />as ededdy Section 9002 of the Resoppne Co r�f oepgA Rey Yely Aet,(R A), <br />d. <br />The primary purpose of this notification program is to locate and evaluate unler- <br />ground tanks that store or have stored petroleum or ftaxardot{rst�stances. is <br />expected that the information you p�ovide will be-based,on rea$onably avail ble <br />records, or. in the absence of such records, your knbMddgerW cf. of recollectio <br />Who Must Notify? Section 9002 bf-trCRA" aSa'mended:'feq'uires'iliat. `6-niess <br />exempted. owners of underground tanks that store regulated substances must notify <br />designated State or local agencies of the existence of their tanks. Owner means — <br />(a) in the case of an underground storage tank in use on November 8, 1984. or <br />brought into use after that date. any person who owns an underground storage tank <br />used for the storage. use. or dispensing of regulated substances. and <br />(u) in the case of any underground storage tank in use before November 8, 1984. <br />but no longer in usepn that date. any person who owned such tank immediately before <br />the discontinuation of its user ' <br />What Tanks Are, includei ?, Underground storage tank is defined as any one orb <br />combination of tanks that (I ) is used to contain an accumulation of "regulated sub <br />stances." and (2) whose volume (including connected underground piping) is 100/0or <br />more beneath the ground. Someexamples are underground tanks storing: l.gasoline, <br />used oil. or diesel fuel. and 2. industrial solvents. pesticides. herbicides or fumigants. <br />What Tanks Are Excluded? Tanks removed from the ground are not subject to <br />notification. Other tanks excluded from notification are: <br />1. farm or residential tanks of 1.100gallons or less capacity used for storing motor fuel <br />for noncommercial purposes: <br />2. tanks used forstoring heatingoil forconsumptive use on the premises where stored: <br />3. septic tanks: <br />STATE USE ONLY <br />I.D. Number . , _ i <br />Date Received <br />317) 243-OM <br />4. pipeline facilities (including gathering lines) regulated under the natural Gas <br />Pipeline Safety Act of 1968. or the Hazardous Liquid Pipeline Safety Act of 1979. or <br />which is an intrastate pipeline facility regulated under State laws: <br />5. surface impoundments. pits. ponds. or lagoons: <br />6. storm water or waste water collection systems: <br />7. flow -through process tanks: <br />8.liquid traps orassociated gathering linesdirectly related to oil organ production and <br />gathering operations: <br />9. storage tanks situated in an underground area (such as a basement, cellar. <br />mineworking. drift. shaft. or tunnel) if the storage tank is situated upon or above the <br />surface of the floor. <br />What Substances Are Covered? The notification requirements apply to under- <br />ground storage tanks that contain regulated substances. This includes any substance <br />defined as hazardous in section 101 (14) of the Comprehensive Environmental <br />Response. Compensation and Liability Act of 1980 (CERCLA). with the exception of <br />those substances regulated as hazardous waste under Subtitle C of RCRA. It also <br />includes petroleum. e.g., crude oil or any fraction thereof which is liquid at standard <br />conditions of temperature and pressure (60 degrees Fahrenheit and 14.7 pounds per <br />square inch absolute). <br />Where To Notify? Completed notification forms should be sent to the address <br />given at the top of this page. <br />When To Notify? 1. Owners of underground storage tanks in use or that have been <br />taken out of operation after January I, 1974, but still in the ground, must notify by <br />May 8, 1986. 2. Owners who bring underground storage tanks into use after May 8, <br />1986. must notify within 30 days of bringing the tanks into use. <br />Penalties: Any owner who knowingly fails to notify or submits false information <br />shall be subject to a civil penalty not to exceed S10,000 for each tank for which <br />notification is not given or for which false information is submitted. <br />Please type or print in ink all items except "signature" in Section V. Thisform must by completed for Indicate number of <br />each location containing underground storage tanks. If more than 5 tanks are owned at this location, continuation sheets <br />photocopy the reverse side, and staple continuation sheets to this form. I attached <br />ter Name (Corporation, Individual, Public Agency, or Other Entity) <br />CITY OF SOUTH BEND WATER WORKS <br />Street Address <br />915 SOUTH OLIVE STREET <br />County <br />ST.JOSEPH <br />(If same as Section 1, mark box here 0 ) <br />Facility Name or Company Site Identifier, as applicable <br />Street Address or State Road, as applicable <br />City State ZIP Code I County <br />SOUTH BEND INDIANA 46619 <br />Area Code Phone Number <br />Type of Owner (Mark all that apply(M) <br />❑ Current ® State or Local Gov't ❑ Private <br />Corporatt <br />e <br />❑ Former ❑ Federal Gov't ❑ Ownership <br />(GSA facility I.D. no. uncertain <br />City (nearest) State ZIP Code <br />Indicate Mark box here if tank(s) <br />number this <br />are located land within ❑ <br />tanks at this 2 anIndian reseservationor <br />location on other Indian trust lands <br />Name (If same as Section 1, mark box here ❑ ) Job Title Area Code Phone Number <br />FRANK HORVATH OPERATION SUPERINTENDENT 219 284-9464 <br />IV. TYPE OF NOTIFICATION <br />❑ Mark box here only if this is an amended or subsequent notification for this location. <br />I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached <br />documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the <br />submitted information is true, accurate, and complete, <br />Name and official title of owner or owner's authorized representative Signature / Date Signed <br />FRANK HORVATH, OPERATION SUPERINTENDENT �- / 49 / y — S <br />