Laserfiche WebLink
STATE ID NUMBER 00000014552001 <br /> CONTAINER CONSTRUCTION <br /> E. 1 01 RUBBER LINED f 1 02 ALKYD LINING f 1 03 EPDXY LINING ( 1 04 PHENOLIC LINING f 105 GLASS LINING <br /> ( ) 07 UNLINED fX) 08 UNKNOWN t ) 09 OTHER: <br /> F. f l 01 POLYETHLENE WRAP ( ] 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION f 1 04 UNKNOWN ( 1 05 NONE <br /> (X) 06 TAR OR ASPHALT f 1 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 (X) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH f ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ESI ( ) 04 PRESSURE (X] 005 SUCTION ( ] 06 UNKNOWN ( 107 NONE <br /> VII LEAK DETECTION <br /> U('r01 VISUAL pG 02 STOCK INVENTORY [ 1 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> GROUND .TER MONITORING WELLS 9(1 07 PRESSURE TEST ( ) 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 CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> ( ) 01 ( l 02 f 1 03 <br /> ( ) O1 ( ] 02 ( ) 03 <br /> f ) 01 ( 1 02 ( ) 03 <br /> ( ) 01 [ ) 02 ( ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( l Ol ( ) 02 ( ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( 1 Ol f ) 02 ( 1 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? f 1 01 YES (X) 02 NO <br /> THIS FORM HAS BLIONOtl <br /> "PLLEETTED NOER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PERSON FILINGui PHONE W/AREA CODE Ito <br /> FOR LOCAL AGENCY USE ONLY (V97'�7 <br /> AD MI STRATINQ AGENCY _ ` CITY CODE COUNT CODE <br /> CONTAC PERSON 19 PHONE �WW/AREA COD! <br /> o �- <br /> DATE OF LAST INSPECTION ICOMPLIANCE PERMIT APPROVAL DATE TRANSACTION DAT! LOCAL PERMIT ID # <br /> ( ) 01 YES f ) 02 NO <br /> HSC04-070185 (10/18/85) �)� PAGE 2 <br />