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STATE FIRE ~ttP~HAL OFFICE <br />3000 Harket Street Plaza N.E. <br />Salem, C~ 97310 <br /> <br />APPLICATION ~) IN,TAIL PTA~4ABI.E/C~US*PIBLE, LIQUID TANY~S <br /> <br />( ) PiAM~t~BLE LIQUIDS: Storage, HandLing - Over 1,000 Gallons <br /> <br /> Quantity Buried <br /> <br />~) CO~IBUSTIBLE LIQUIDS: Storage, Handling - Over 1.OO0 Gallons <br /> Quantity ~c~a> ~;> Buried <br /> <br />Above Ground <br /> <br />Above Ground <br /> <br />( ) LIQUEFIED PETROLE~ GAS: Storage, Hand hng - Over 2,000 Gallons <br /> <br />Co~r~rcial Bulk Plant Industrial Quantity <br /> <br />NOTE: Flam~ble liquids have a flashpoint below iO0~F. <br /> Combustible liquids have a flashpoint above lOOeF. <br /> <br />Located on premises known as: ~Sq ¢.~-~E¢._ .~% ,_L~v~-*, <br /> <br />It is understood and agreed upon, that this installation shall be in full cc~pliance with appli- <br />cable statutes of the State of Oregon and any local codes or ordinances. <br /> <br /> APPROVAI~ <br /> <br />~~¢--~~flease P~int ~f:P~;~'ning/Zoning Official <br /> Sign~re b~ Plmn~ing/Zoning <br /> <br />Date of Signature <br />~(i ling Address <br /> <br /> Stature of Fire Chief or Fire Marshal <br /> Signature <br /> <br />.... F~re Department or District <br /> <br />APPLICANT INFORMATION <br /> <br />Cc~npany Installing Tank <br /> <br />Company Representative <br /> <br />N~e of AppLicant if other than a Ccmpany <br />Address of Applicant or Cc~npany <br /> <br /> City),' State Zipcode <br /> <br />Signature of Applicant/Company Representative <br /> <br />Two sets of cx~nstruction plans, including plot location, property lines, location of overhead <br />power and utility lines, a~jacent buildings, tank description and piping system shall accom~%ny <br />this application, which shall be forwarded to the State Fire Marshal. <br /> <br />920-021-215 <br /> <br /> <br />