Laserfiche WebLink
CONTAINER CONSTRUCTION <br /> STATE ID NUMBER 00000037907002 <br /> E. ( ) O1 RUBBER LINED ( ) 02 ALKYD LINING f l 03 EPDXY LINING <br /> (01 07 NLIN ( 7 08 UNKNOWN 09 OTHER: ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> UED ( 7 <br /> F. ( 7 O06 TAR DR ASPHALT LLENS WRAP ( 7 02 <br /> ) 06 <br /> f 1 TAR VINYL WRAPPING ( ) 03 <br /> VI PIPING 09 OTHER: CATHODIC PROTECTION (X) 04 <br /> ( ) <br /> UNKNOWN ( 1 OS NONE <br /> A. A80VESROUND PIPING <br /> HK PPROPRIATE:SOX(ES) f ) O1 0DOUBLE-WALLED PIPE _ <br /> CONR06TRENCH <br /> E <br /> (C <br /> UNKNOWN ECA ( 7 4 PRESSURE 1 1 05 UC � 07NONE <br /> GRAVITY <br /> f <br /> B. UNDERGROUND PIPING: SiIpN <br /> (CHECK APPROPRIATE BOX(ES) (X1 04 PRESSURE ( 7 05 SO1 DOUBLE-WALLED PIPE (UCTION ( ) ( ) <br /> 7 ) 02 CONCRETE-LINED TRENCH ( ) 0; GRAVITY <br /> VII LEAK DETECTION 06 UNKNOWN 07 NONE <br /> `( t 01VISUAL <br /> GROUND( L <br /> WATER MONITORINGNWE <br /> 06LS (( 7) <br /> 04 VAPOR SNIFF WELLS ) 09 NONE ( 7 Ip OTHER: <br /> ( ) 05 SENSOR INSTRUMENT <br /> VIII CHEMICAL. COMPOSITION OF HER: <br /> IF YOU CHECKED YES TO IV•F YOU ARE N07 REQUIRED TEIO COMPLETE THIS SECTION <br /> ALS STORED IN UNDERGROUND CONTAINERS <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) <br /> STORED STORED <br /> CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> f 1 01 ( } 02 ( ) 03 <br /> ( ) 01 f 1 02 _- ( ) 03 <br /> ( ) 01 ( ) 02 ( 7 03 <br /> f 1 01 1 ) 02 ( 7 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> f 7 <br /> 01 ( ) 02 ( ) 03 <br /> ( l 01 ( ) 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 ( ) 03 <br /> ( 7 Ol ( ) 02 ( ) 03 <br /> ( 7 Ol ( ) 02 f ) 03 111 <br /> * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> L5 CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> IS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> EPSON FILING (SIGNATURE) <br /> PHONE WYAREA CODE <br />]R LOCAL AGENCY USE ONLY <br /> MINISTRATING AGENCY <br /> CITY CODE <br /> NTACT PERSON COUNTY CODE <br /> PHONE W/AREA CODE <br />(E OF LAST INSPECTION IN COMPLIANCE <br /> ( ) 01 YES ( ) PERMIT gppROyAI DATE <br /> 02 NO TRANSACTIONGATE LOCAL PERMIT IG # <br /> 14-070185 (10/18/85) <br /> PAGE 2 <br />