BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

`o STATE ID NUMBER 00000066093002 CONTAINER CONSTRUCTION E. t 101 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING [ 1 04 PHENOLIC LINING ( 1 05 GLASS LINING (X) 07 UNLINED ( ) 08 UNKNOWN ( 109 OTHER F. ( ) 01 POLYETHLENE WRAP ( l 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION l l 04 UNKNOWN (X) 05 HONE ( ) 06 TAR OR ASPHALT f ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: f ) 01 DOUBLE-WALLED PIPE f ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE S. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( l 06 UNKNOWN l 107 NONE VII LEAK DETECTION ( ) 01 VISUAL (X) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( 105 SENSOR INSTRUMENT I 106 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STORED STORED ( ) O1 ( ) 02 ( 103 ( ) Ol 1 ) 02 f 1 03 ( 1 Ol ( 1 02 ( 1 03 ( ) Ol f ) 02 ( 1 03 f I 01 ( ) 02 l 103 [ l 01 ( l 02 f ) 03 ( 1 O1 ( ) 02 ( ) 03 t 1 01 ( ) 02 ( ) 03 l ) O1 ( 102 ( ) 03 f 1 01 ( 1 02 ( ) 03 • CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO THIS F04 HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PERSON FI;l (S E1 P �ON,EgW/AREA COD�F - 33 OV 1 `�S FOR LOCAL AGENCY USE ONLY ADMINISTRATING AGENCY CITY O COUNTY CODE s 1 ci- CONTACT PER � PHO E W/9 DATE Of LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # ( ) 01 YES ( ) 02 NO • HSC04-070185 (08/29/86) PAGE 2