Laserfiche WebLink
CONTAINER CONSTRUCTION STATE ID NUMBER <br /> E. 1 1 O1 RUcBER LII:Lp �..• <br /> 1 ) 02 ALKYD LIN- 1 ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING <br /> 07 UN LIY.EO 1 1 OB UKriKCwN ( ) 09 OTNER: <br /> ( 1 OS GLASS LIN.t;3 <br /> 01 POLYS TN LENS A ( ) 02 VINYL WRAPPING <br /> 1 Ob TAR OR ASPHALT P'4, 09 OTHER: ( ) 03 CATHODIC PROTECTION ( 1 04 U:O:I;O6N 1 1 05 NONE <br /> 1 <br /> fiber lass Coatin <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( 1 01 DOUBLE-WALLED PIPE 1 1 02 CONCRETE-LINED TRENCH <br /> (CHECK APPROPRIATE BOX(ES). (•. ) 04 PRESSURE 05 SUCTION ( 1 06 URO:NOWN ( ) 07 NONE <br /> GRAVITY <br /> B. UODERGROLM PIPING: DQ 01 DOUBLE-WALLED PIPE f 1 02 CONCRETE-LINED TRENCH <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE I�Q OS SUCTION 1 1 06 UNKNOWN f ) 07 CF0L0 3 GRAVITY <br /> VII LEAK DETECTION ' <br /> 1 1 <br /> 01 VISUAL I ) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS 1>< 05 SENSOR INSTRUMENT <br /> 1 1 06 GROUND WATER MONITORING WELLS ( 1 07 PRESSURE TEST 1 1 09 NONE pQ 30 OTHER: IElOnitor Well in tank <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS backfill <br /> IF YOU [NECKED YES TO IV•► YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CASE (IF KNOWN) <br /> STORED STORED CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> ( ) 01 1 ) 02 ( ) 03 Lu I <br /> 1 ) O1 1 ) 02 ( ) 03 <br /> 1 101 ( 102 1 103 <br /> 1 101 1 ) 02 1103 <br /> 1 1 <br /> 01 1 1 02 1 ) 03 <br /> 1 ) <br /> 01 ( 1 02 ( 1 03 <br /> ( 101 1 102 1 ) 03 <br /> 1 ) 01 l 102 1 103 <br /> 1 101 1 IO2 f 103 <br /> 1 ) Ol ( 1 02 1 ) 03 <br /> • CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> 35 CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( 1 01 YES fP02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER HE PENALTY OF PERJURY AID, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PERSON FILING (SIGNATURE L.B.M.E. PHONE W�AREA CODE <br /> for Pacific Bell Corporation (916) 972-9010 <br /> FOR LOCAL AGED USE ONLY <br /> ADMINISTRATING AGENCY CITY CODE COUNTY CODE <br /> CONTACT PERSON PHONE WAREA CODE <br /> DATE OF LAIT INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID t <br /> 1 ) O1 YES ( 1 02 NO J <br /> H5C04-070185 (07/03/87) PAGE 2 <br /> v <br />