BILLING - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER 00000016769005 CONTAINER CONSTRUCTION E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( 1 03 EPDXY LINING ( 1 04 PHENOLIC �LINING l 105 GLASS LINING ( ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER- F. 1 1 01 POLYETHLENE WRAP ( 1 02 VINYL WRAPPING 1 ) 03 CATHODIC PROTECTION 1X1 04 UNKNOWN I ) 05 NONE 1 ) 06 TAP. OR ASPHALT ( 1 09 OTHER: I PIPING A. ABOVEGROUNO PIPING: ( ) 01 DOUBLE-WALLED PIPE l ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE 8. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION l 1 06 UNKNOWN ( 1 07 NONE II LEAK DETECTION ( ) 01 VISUAL CWQ 02 STOCK INVENTORY ( 104 VAPOR SNIFF WELLS l ) 05 SENSOR INSTRUMENT l ) 06 GROUND WATER MONITORING WELLS C ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: III CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURPEN'.LT FPEVICUSLY DELETE CASK (IF KNOWN( CHEMICAL (00 NOT USE COMMERCIAL NAME) STC=EJ STORED ( 1 01 ( ) 02 ( ) 03 1 ) 01 ( 1 02 ( ) 03 ( 1 01 ( 1 02 ( ) 03 ( ) 01 l ) 02 ( ) 03 ( 1 01 ( 1 02 ( ) 03 ( 1 01 l 1 02 ( ) 03 ( ] O1 1 1 02 ( 1 03 ( ) 01 f ) 02 ( ) 03 ( 1 01 ( ) 02 ( ) 03 ( I O1 ( 1 02 ( 1 03 • CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( I O1 YES (X) 02 NO IS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE( IS TRUE AND CORRECT. ;PERSON FI I G (SIG NATU PH E W.'ARE COCE L d'1)CRA?7mus Za t S FWR LOCAL AGENCY USE ONLY ADMINISTRATING AGENCY CITY 000E COUNTY CODE CONTACT PERSON PHONE W/AREA CODE DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT IO R ( ) 01 YES 1 1 02 NO PAGE 2 LSC04-070185 (10/18/85)