Laserfiche WebLink
STATE ID NUMBER 00000006886003 <br /> CONTAINER CONSTRUCTION <br /> 01 RUBBER LINED ( ) 02 ALKYD LINING f l 03 EPDXY LINING ( l 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> ( ) 07 UNLINED (X) 08 UNKNOWN i ) 09 OTHER: <br /> O1 POLYETHLENE WRAP [ l 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( ) 05 NONE <br /> i ) 06 TAR OR ASPHALT t ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: t ) O1 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH { ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( 1 05 SUCTION (X) 06 UNKNOWN [ ) 07 NONE <br /> VII LEAK DETECTION <br /> i ) 01 VISUAL (X) 02 STOCK INVENTORY I ) 04 VAPOR SNIFF WELLS f ) 05 SENSOR INSTRUMENT <br /> 0V GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST [ ) 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 REQUIRED TO COMPLETE THIS SECTION <br /> CUP.PENTLY PREVIOUSLY DELETE GAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STCPEO STCPEO <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 ( ) 03 <br /> ( ) O1 [ ) 02 ( ) 03 <br /> ( ) 01 { ) 02 ( ) 03 <br /> 1 ) 01 ( ) '02 ( J 03 <br /> ( ) 01 C ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 [ ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( D 01 ( ) 02 ( l 03 <br /> * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> EISCQ:NTAl:N:E:R LOCATED ON AN AGRICULTURAL FARM? t ) 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 /> PERSON FILING (SIGNATURE) PHONE W/AREA CODE <br /> D <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTRATING AGENCY CITY CODE COUNTY CODE <br /> CONTACT PERSON PHONE W/AREA CODE <br /> DATE OF LAST INSPECTION IN COMPLIANCE � ERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT SD # <br /> ( 1 01 YES i i 02 NO <br /> PAGE 2 <br /> HSC04-070185 (10/18/85) <br /> 0 <br />