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CONTAINER CONSTRUCTION - STATE ID NUMBEN <br /> E____�__ <br /> RUBBER LINED02 ALKYD LINING f 1 O3EPO%Y LINING ( 1 04 M1ENOlIC LININGOS GLASS LINING <br /> 07 UNLINED ( 1 OB UNKNOWN ( ) 09 OTHER:O1 POLYETHLE14E WRAP f1 0-2VINYL NR-----1 06 TAR OR ASPHALT f 1 09 OTHER: f 1 O3 CATHODIC PROTECTION f 1 D4 UNKNOWN --- <br /> l�l OS NONE <br /> YI PIPING <br /> FABOVEGROUNDPIPING:APPROPRIATE BOX(ES1 1 04 PRESSURE ( 1 05 SUCTION f ) 06 UNK1 01 DOUBLE-MALLEO PIPE1 02 CONCRETE-LINED TRENCH ( 1 03 GRAVITY <br /> OU14D PIPING: NOUN f 1 07 NONE <br /> APPROPRIATE BOX)ESI 1 ) 04 PRESSURE f 1 05 SUCTION ( 1 06 )INK <br /> 1 DOUBLE-WALLED PIPE 1 ) 02 CONCRETE-LINED TRENCH f 1 03 GRAVITY <br /> MOWN f 1 07 NONE <br /> VII LEAK DETECTION <br /> 1 1 �106 <br /> ISUAL f 02 STOCK INVENTORY 1 104 VAPOR SNIFF HELLS 1 1 05 SENSOR INSTRUMENT <br /> f GP,OlR10 WATER Mg1ITORING WELLS f 1 07 PRESSURE TEST 1 1 09 NONE f� 30 OTHER: <br /> /--�!.� <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-f YOU APE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS■ lIf } <br /> STONED STOPED KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> l 101 l l02 ( 103 ) I I I I I I I I I I I I <br /> 1 1 Ol 1 1 02 f l OS ) I I I ' I I <br /> f 1 Ol f 1 02 ( ) 03 ALL <br /> ' 1 101 l 102 ( 103 I I I I I I I I I I <br /> 1 101 ( 102 1 1 03I I I <br /> 1 1 <br /> 01 1 1 02 l ) 03 <br /> of O02 I ) 031111111111111 <br /> ' ( ) 01 102 " 03 LI I I I I I I I I I I I <br /> � 1 1 01 ( ) 02 1 ) 03 <br /> , I ) 01 f 102_ ' 11031 I I I I I I I I I I I I <br /> LIC��ITANER LOCATED ON AN AGRICULTURAL FARM? 1 1 01 YESh 02 NO <br /> MIS FORM HAS BEEN COMPLETED )RIDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PCGjp F lF PHONE W/ARE[A—CODE <br /> FOR LOCAL AGENCY USE ONLY <br /> .0. 1111STPAT n^ .,E,4:y 1 CITY CODE COUNTY CODE <br /> CONTACT oEKS �N PN NE W/AP CODE <br /> CATE OF LAST INSGECTIONrlNOMPLIANCEol 'Es ) IPEPMIi AP►ROYAL DATETRANSACTION DATE IIOGI PENMiT IDCATE OF LAST INSVECTION OMPLIANCE,ISC04-079185 Il JI PAGE 2 <br /> r f <br />