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wr.. i . • STATE ID NUMBER 00000036670002 <br /> CONTARRPINER CNHONSTRUCTION <br /> E. ( 1(0� 07BUNLINEDEO( ) 080 UNKNOWN L(X)N09 OTHERS EBOo <br /> LACKLTARNG ( 7 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> F ( 1(01 06LTARHORNASPHALT ((1)009VOTHL WRAPPING ( 1 03 CATHODIC PROTECTION ( 1 04 UNKNOWN (X) 05 NONE <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) O1 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ] 03 GRAVIT <br /> (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE ( 1 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING ( ) Ol DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH f ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE lX) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTIONNSTRENT <br /> (X( Ol OVISUALGROUND(WAT02 STOCK ER MONITORING NWEL LS TOY ((11007V PRESSUREAPOR F TESTEES 1(09 NONE I0 <br /> 10 OTHER: <br /> VIII YGCHEMICALEs ODMPOSITION O; PMuiREo ro COMPLETE THIS ORED IN IDF you UNDERGROUND CONTAINERS <br /> CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> CUPPENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) <br /> STORED STORED <br /> ( ) Ol ( ) 02 ( 1 03 <br /> ( ) Ol ( 1 02 f ) 03 <br /> ( ) Ol ( 1 02 ( ) 03 <br /> ( ) 01 ( l 02 [ ) 03 <br /> ( 1 <br /> 01 ( ] 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 ( ) 03 <br /> ( 1 Ol ( ) 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 ( ) 03 <br /> ( 7 <br /> 01 ( 1 02 ( ) 03 <br /> ( ) Ol ( ) 02 l ) 03 <br /> x CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> I5 CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) O1 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MyNOWLEDGE, IS TRUE AND CORRECT. <br /> PHONEWR <br /> FEPSON FILING (SIGNATURE) <br /> FOR LOCAL AGENCY USE ONLY CITY CODE COUNTY CODE <br /> ADMINISTRATING AGENCY <br /> PHONE W/AREA CODE <br /> CONTACT PERSON <br /> DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION GATE LOCAL PERMIT ID # <br /> ( ) O1 YES ( 7 02 NO <br /> PAGE <br /> HSC04-070185 (10/18/85) <br />