Laserfiche WebLink
STATE ID NUMBER 00000011183003 <br /> CONTAINER CONSTRUCTION <br /> FE. ( 1 01 RUBBER LINED i 1 02 ALKYO LINING ! } 03 EPDXY LINING ( 1 04 PHENOLIC LINING [ } 05 GLASS LINING <br /> (Xl 07 UNLINED i 1 08 UNKNOWN ( f 09 OTHER:1 01 POLYETHLENE WRAP i 1 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION I 1 04 UNKNOWN fX1 fly NONE <br /> t i O6 TAR OR ASPHALT [ 1 09 OTHER. <br /> v PIPING <br /> A. ABOVEGROUND PIPING l 1 O1 DOUBLE—WALLED PIPE [ 1 02 CONCRETE—LINED TRENCH f } 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ESI ( 1 04 PRESSURE ( ) 05 SUCTION i 1 Ob UNKNOWNf } 07 NONE <br /> B. UIdOfPGROUNO PIPING! ( 1 01 DOUBLE—WALLED PIPE f 1 02 CONCRETE—LINED TRENCH f 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) i 1 04 PRESSURE (X) 05 SUCTION i 1 06 UNKNOWN l 1 07 NONE <br /> VII LEAK DETECTION <br /> i 1 01 VISUAL (X) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS f 1 05 SENSOR INSTRUMENT <br /> f 1 06 GROUND WATER MONITORING WELLS f 1 07 PRESSURE TEST ( 1 09 NONE ( 1 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> I° YCU CrECyID Y`S TO :V-F 1`QU APE NOT PEC°JIFED TO COMPLETE THIS SECTION <br /> C::=PENTLY PPE'lICUSLY DELETE CASz fIF KNOWN) <br /> CHEMICAL (DO NOT USE COM`IEPCIAL N4M_ l <br /> S70NSD -- - - <br /> l 1 O1 f 1 02 ( 1 03 — <br /> f 1 01 f 1 02 ! 1 03 — <br /> t 1 01 f 1 02 ( } 03 - <br /> 4 1 <br /> 01 f 1 02 i 1 03 --- <br /> ( 1 01 ( 1 02 f 1 03 <br /> 11 <br /> 01 i 1 02 1 1 03 <br /> 11 01 ( 1 02 i 1 03 <br /> 1 1 01 i ] 02 1 1 03 -- <br /> - [ 1 01 f 1 02 ( 1 03 -- <br /> l 1 01 ( 1 02 ( } 13 -- - —. <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> � ( 3 O1 YES fXl 02 NO _ -- - ----- ---.�. .. <br /> 15 CONTAINER LOCATED ON AN AGRICULTURAL FARM. <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY Of PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. - <br /> - -.-- SI:rli <br /> FILY;Y;, .%TiPEI PHONE W 'aPEA COOE -- -� <br /> P�cSJ.*1 I <br /> FOR LOCAL AGENCY USE ONLY 1 <br /> N_ __ <br /> C27r LOPE � OUnTi� CCIE----------- — �1 <br /> J�`12 NISTF T„'3 E7`_NC, 4 <br /> (fL/✓\ <br /> H NE W AGE CODE <br /> CONTACT PE=SON' <br /> S� PECC^IT APPPC,'al �7=+E TPeNSACTICN DAT: LOCAL P*PM�IT :0 .� <br /> D-” C` t�ST -.SPECTICN i4 CO�"PLiaN <br /> 1 01 E S 1 0 2 SO — <br /> PAGE <br /> HSC04-070185 (10/18/85) <br />