BILLING 1985 - 1998 - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER 00000004628005 CONTAINER CONSTRUCTION E. ( ] 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( 1 05 GLASS LINING ( l 07 UNLINED (X) 08 UNKNOWN t 1 09 OTHER: F. ( 1 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING [ l 03 CATHODIC PROTECTION ( ) 04 UNKNOWN (X) 05 NONE ( l 06 TAR OR ASPHALT t l 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE B. UNDERGROUND PIPING: ( 1 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH (X) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( 1 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE VII LEAK DETECTION (Xl 01 VISUAL ( ) 02 STOCK INVENTORY ( l 04 VAPOR SNIFF WELLS t l 05 SENSOR INSTRUMENT ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE ( 1 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU APE NOT PEGUIPED TO COMPLETE THIS SECTION CURPENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) STOPED STORED (X) 01 t ) 02 ( 1 03 OIL AND GREASE ( ) 01 ( l 02 ( 1 03 ( 1 01 t ) 02 ( 1 03 ( ) 01 ( ) 02 ( l 03 ( 101 ( ) 02 ( l 03 ( 1 01 ( ) 02 ( 1 03 ( l 01 ( ) 02 t l 03 t J 01 ( ) 02 ( ) 03 t ) 01 ( ) 02 I ) 03 ( r 01 ( ) 02 ( 1 03 CHECK STATE SCARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( l 01 YES (X) 02 NO THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PEPSON FILING (SIGNATURE) PHONE W/AREA CODE FOR LOCAL AGENCY USE ONLY ADMINISTRATING AGENCY CITY CODE COUNTY CODE i CONTACT REPSON PHONE W/AREA CODE DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # ( ) 01 YES ( ! 02 NO J4-070185 (10/16/85) PAGE 2