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0 <br /> STATE ID NUMBER 00000014594003 <br /> CONTAINER CONSTRUCTION <br /> E. ( 1 01 RUBBER LINED ( ) 02 ALKYD LINING ( 1 03 EPDXY LINING ( i 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> (XI 07 UNLINED ( 1 08 UNKNOWN ( ) 09 OTHER: <br /> F. ( ) 01 POLYETHLENE WRAP ( 1 42 VINYL WRAPPING N ( 9 04 UNKNOWN ( 1 05 NONE <br /> ( 06 TAP. OR ASPHALT ( 1 09 OTHER' <br /> VI PIPING _ <br /> A. ABOVEGROUND PIPING- ( 1 01 DOUBLE-WALLED PIPE ( i 02 CONCRETE-LINED TRENCH ( 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOX ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: ( 1 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) 04 PRESSURE ) 06 UNKNOWN ( ) 07 NONE <br /> l <br /> VII LEAK DETECTION <br /> ( ) 01 VISUAL (X) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> ( J 06 GROUtiD WATER MONITORING WELLS (X) 07 PRESSURE TEST ( 1 09 NONE ( l 10 OTHER <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED "fES TO IV-F YOU APE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CUPPENTLY PPEVICUSLY DELETE CASK (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STOPED STOPED <br /> [ 1 01 ( 1 02 ( ) 03 <br /> ( ) 01 ( 102 ( ) ©31111111111111 <br /> ( ) 01 ( 1 02 ( ) 03 <br /> ( ) 01 C 0 ( ) 01111111111111 <br /> ( 1 01 ( 1 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( 1 03 <br /> ( 1 01 ( i 02 ( l 03 <br /> 01 ( ) 02 ( i 03 <br /> ( ) 01 ( J 02 ( l 03 <br /> ( J 01 ( ) 02 ( 1 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? l 1 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> I <br /> PEPSON FILING (SIGNATUP-) PHONE W/AREA CODE <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTRATING AGENCY CITY CODE COUNTY CODE <br /> IA 1'8 LU cA L c4 5l <br /> CONTACT PERSJV, ` `�� U��_�� PHONE WfAREA COOE� '�O it <br /> DATE OF LAST IN PECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # <br /> rJ _ ( ? 01 YES ( 1 02 NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br />