CHEMICAL TANK QUESTIONNAIRE

3. What is the name of the chemical to be stored? If the chemical will be a mixture of chemicals, list each component and the percent concentration (sum of concentrations should total 100%). Include trace chemicals and reaction gases or liquids.

Note: If only "trade names" are known, list the trade name, the name of the manufacturer, and a list of the individual components if known. Copies of MSDS(s) may be requested by CSI.

(1) Accounts for the possibility that a single component of a mixture could be dumped into the tank or basin.

(2) If the chemical is water (other than potable water or rain water) such as de-ionized, pure, ultra-pure, etc., show the concentration in ohm/cm.

(3) If chemical is listed in Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), the tank must be double wall.

Maximum Residence Time @ Max. Concentration

Product Listed in CERCLA as Hazardous (yes/no)(3)

4. Specific gravity range of the chemical or mixture:

to

5. pH range of the chemcial or mixture:

to

7. Is the fluid/chemical soluble in water?

8. If a mixture, will the mixture:

9. Will the chemicals be under constant agitation?

12. If a chemical process or the mixing of chemicals will be done in the tank or basin, in the comments section below:

• Identify the reaction or mixing process
• The chemicals used or created
• Presence of agitation (continuous or intermittent)
• Quantify the heat generation
• How chemicals are introduced into the vessel (i.e., drop tube, side wall port, top grate, etc.)

11.Burial depth (grade to tank top):

feet

6. What are the normal operating temperatures?

Upset Maximum temp:

Duration:

hrs?