Laserfiche WebLink
STATE IO NUMBER 00000011982005 <br /> CONTAINER CONSTRUCTION <br /> E( ) <br /> RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( 1 05 GLASS LINING <br /> 07 UNLINED ( ) OB UNKNOWN ( ) 09 OTHER: <br /> POLYETHLENE WRAP f ) 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION (X1 04 UNKNOWN ( ) 05 NONE <br /> 06 TAR OR ASPHALT ( ] 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B <br /> (CHECK APPROPRIATE.BOX(ES) ( ( 0104 PRESSURELE(X) 05 SUCTION CONCRETE-LINED 06UNKNOWNTR EN) 07 NONE3 GRAVITY <br /> VII LEAK DETECTION <br /> ( 1 01 VISUAL (X) 02 STOCK INVENTORY f l 04 VAPOR SNIFF WELLS ( 1 05 SENSOR INSTRLMIENT <br /> ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( 1 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CASE (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STOPED STORED 'J <br /> (X) 01 ( 1 02 ( 1 03 > <br /> ( ) O1 ( 1 02 ( ) 03 <br /> ( ) 01 ( 7 02 ( ) 03 <br /> ( ) OI ( ) 02 [ ) 03 <br /> ( ) 01 ( ) 02 ( 1 03 <br /> ( 1 <br /> 01 ( ) 02 ( 1 03 <br /> ( 1 O1 ( 1 02 ( 1 03 <br /> ( ) O1 ( ) 02 ( ) 03 <br /> ( 7 O1 ( ) 02 ( ) 03 <br /> ( ) 01 f ) 02 ( 7 03 <br /> • CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? (X) 01 YES ( ) 02 NO <br /> THIS FORM BEEN CO T ER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> P ,II NNGG ,(SIGN URE PHONE W/AREA CODE <br /> FOR LOCAL AGENCY USE ONLY \ <br /> ADM�rJZNCY q CITY CODE COUNTY CODE <br /> CONT T PERSON PHqNE W/AREAA CODE <br /> C <br /> DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DAT! TRANSACTION DATE LOCAL PERMIT 20 II <br /> ( ) OI YES ( ) 02 NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br />