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STATE IO NUMBER 00000048240002 <br /> CONTAINER CONSTRUCTION <br /> E. f 1 01 RUBBER LINED ( ) 02 ALKYD LINING i 1 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( 1 05 GLASS LINING <br /> ( ) 07 UNLINED (X) 08 UNKNCWN ( ) 09 OTHER: <br /> F. ( ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING [ ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( l 05 NONE <br /> 4 ) 06 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( 1 05 SUCTION ( ) 06 UNKNOWN ( 1 07 NONE <br /> B. UNDERGROUt)D PIPING: ( J 01 OCUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH f ) 03 GRAVITY <br /> (CHECK APPROPRIATE SOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( ) 06 UNKNOWN ( 1 07 NONE <br /> VII LEAK DETECTION <br /> ( ) <br /> 01 VISUAL ( ) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS f ) 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS i ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU APE NOT REGUIPED TO CCMPLETE TX:S SECTION <br /> CUPPENTLY" PREVIOUSLYDELETE CAS# (IF KNCWN) CHEMICAL (DO NOT USE COMMERCIAL NAME ) <br /> STOPED STOPED <br /> ( 1 01 ( ) 02 ( 1 03 <br /> ( ) 01 ( l 02 ( ) 03 I <br /> [ ) 01 ( J 02 ( ) 03 <br /> 1 01 C ) 02 ( ) 03 <br /> E ) 01 ( ) 02 ( ) 03 <br /> f 1 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( ) <br /> 01 [ 1 02 ( ) 03 <br /> [ ) 01 l ) 02 ( 1 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, 15 TRUE AND CORRECT. <br /> :EPSON FILING PHONE W/AREA CODE 7 <br /> FOR LOCAL AGENCY USE ONLY <br /> AOM.iN'_S-uRAT .P- AGENCY CITY C DE COUNTY CODE <br /> �� l.(.(. �C.- / <br /> CONTACT. -EPSON PHONE W!AP A CGDE 7 <br /> DA'7E OF LAST iNSPECTION SN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LCCAL PERMIT IO # <br /> ( l 01 YES ( ) 02 NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br />