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Container Construction <br /> E. O at Rubber Lined O oz Alkyd Lining O o3 Epoxy Lining O a. Phenolic Lining O as Glass Lining ❑os Clay Lining <br /> O m Unlined P-oe Unknown O w Other: <br /> F. O of Polyethlene Wrap 00 Vinyl Wrapping O o3 Cathodic Protection <br /> goo Unknown O os None O oe tar or asphalt O as, Other. <br /> VI Piping <br /> A. Aboveground Piping: O al Double walled pipe O oz Concrete-lined trench O as Gravity O os Pressure O Ds Suction <br /> [(Check) appropriate box(es)] O oe Unknown 007 None <br /> B. Underground Piping: O of Double-walled pipe O oz Concrete-lined trench O os Gravity pas Pressureos Suction <br /> [(Check) appropriate box(es)] Zoe Unknown O oT None ���'�'� <br /> VII Leak Detection <br /> Oat Visual O oz Stock Inventory O 03 Tile Drain ON Vapor Sniff Wells O as Sensor Instrument <br /> O as Ground Water Monitoring Wells O o, Pressure Test O oe Internal Inspection Xoe None <br /> O to Other: <br /> VIII Chemlcal Composition of Materials Currently or Previously Stored in Underground Containers <br /> It you checked yes to IV-F you are not required to complete this section. <br /> mro ny Oro'IODEb CMrsskal Do No,use Commeraar Name (use addNonal pacer tar shoe room <br /> stored shed CAS p(u known <br /> 00 002 <br /> 001 Ooe <br /> OOT O oz <br /> Is Container located on an Agricultural Farm? Ool Yes 0De No <br /> Person Filing(Signature) Phone wishes code <br /> For Local Agency Use Only <br /> AGENCY NAML <br /> EIIY COVNTT <br /> CONTACT PENNON PHONE W/AICA CODE <br /> INSPECTION DATE NIST INSPECTION) PERMIT APPROVAL DATE PERMIT ID. NUMBER <br /> FOR STATE USE ONLY <br /> STATE ID. NUMBER ACCouneng Number County NumbeN <br /> Dale ACCerVCC ❑of ❑p2 O m <br />