Laserfiche WebLink
CONTAINER CONSTRUCTION STATE IO NUMBER 00000035002014 <br /> E101 <br /> ER LINED 1 ) 02 ALKYD LINING f 1 03 EPDXY LINING 1 1 04 PHENOLIC LINING ( l 05 GLASS LINING <br /> NLINED [X) OB UNKNOWN ( 1 09 OTHER: <br /> THLENE WRAP ( 1 02 VINYL WRAPPING f ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN1 l OS NONE <br /> R OR ASPHALT l ) 09 OTHER: <br /> VI PIPING <br /> F(CHECK <br /> EGROUND PIPING: f ) 01 DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH l 1 03 GRAVITY <br /> CK APPROPRIATE BOXIEST l ) 04 PRESSURE ( i 05 SUCTION [ ) 06 UNKNOWN 1 ) 07 NONE <br /> RGROUND PIPING: f ) 01 DOUBLE-WALLED PIPE 1 1 02 CONCRETE-LINED TRENCH l 1 03 GRAVITY <br /> APPROPRIATE 80X1 ESI IM) 04 PRESSURE DCl ONION ( l 06 UNKNOWN ( 1 07 NONE <br /> VII LEAK DETECTION <br /> I ) O1 VISUAL (k� INVENTORY 1 ) 04 VAPOR SNIFF WELLS I l 05 SENSOR INSTRUMENT <br /> f 1 06 GROUND WATER MONITOR JELLS fj1 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> iF YOU CNECKEO IES TO IV-f YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CU:RENTLY RREVICUSL'i DELETE CASU (IF KNOWN) CNEM.ICAL (00 NOT USE CCM.lfPCIAL NAME ) <br /> SCO='_D STC=!0 <br /> 1 ) 01 ( 1 02 f 1 03 <br /> 1 1 <br /> 01 ( 1 02 1 ) 0; I I I <br /> f l 01 f 1 02 f ) 03 <br /> 1 1 <br /> 01 f l 02 f 1 03 <br /> f 1 01 ( ) 02 ( ) 03 <br /> 11 01 ( 1 02 ( ) 03 I I I <br /> f ) 01 f ) 02 ( 1 03 <br /> ( 1 01 f ) 02 f 1 03 - <br /> f l 01 f 1 02 ( 1 03 <br /> f 101 ( 102 l 103 <br /> P CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> ;!;SON ILiN3 f/IONAT ) / //= ,c/ PNO C /AREA CODE l <br /> 214 <br /> FOR LOCAL AGENCY USE ONLY <br /> ADM;NISTPATIND AGENCY / CITY CODE COUNTY COOL <br /> 1 1-17 <br /> CONTAC PCRSON� F PNONE M/AREA CODC <br /> C l<C�r C5� ee� �Jt iii � ��/r%' / l?c�) l 7- S!'7r <br /> DATE OF LAST SNSPROTSON IN COMPLIANC! PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT IO R <br /> oI res [ ) OR NO <br /> ISC04-070185 (10/10/65) m// 1014 ,3 PAGE 2 <br />