Laserfiche WebLink
STATE I0 NUMBER <br /> CONTAINER CONSTRUCTION <br /> El <br /> oI RU08ER LINED 1 1 02 ALKYD LINING 1 1 O3 EPDXY LINING 1 1 04 PHENOLIC LINING 1 1 OS GLASS LINING <br /> 1 07 UNLINED 1 1 OB UKOWN 1 1 09 OTHER: <br /> O1 POLYETHLE14E WRAP ( 1 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION 1 1 04 UNKNOWN ( 1 05 NONE <br /> 1 06 TAR OR ASPHALT 1 1 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUID PIPING: 1 1 01 DOUBLE-WALLED PIPE 1 1 02 CONCRETE-LINED TRENCH 1 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOXIESI ( 1 04 PRESSURE l 1 05 SUCTION 1 1 06 UNKNOWN l 1 O7 NONE <br /> S. UNDERGROUND PIPING: 1 1 01 DOUBLE-WALLED PIPE 1 1 02 C ETE-LINED TRENCH 1 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOXIESI 1 i 04 PRESSURE 1 1 OS SUCTION ( 06 UNKNOWN 1 1 07 NONE <br /> VII LEAK DETECTION <br /> 1 1 01 VISUAL ( 1 02 STOCK INVENTORY 1 1 04 VAPOR SHIFFWELLS 1 1 OS SENSOR INSTRUMENT <br /> 1 1 06 GP.OUA WATER MONITORING WELLS I 1 07 PRESSURE TEST 1 1 09 NONE 1 1 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> If YOU CMECKEO YES TO IV•F YOU ARE NOT RERUIREO TO COMPLETE THIS SECTION <br /> CVPTCNTLY PREVIOUSLY DELETE CAS■ (If KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> 1 1 01 1 1 02 1 113 I I I I I I I I I I I I I I <br /> 11 01 1 1 02 ( 1 03 LLL <br /> I I I I I I I <br /> 1101 1102 11031111111111111 <br /> l 1 O1 ( 1 02 1 1 03 <br /> 02 110_3lllllllllilll <br /> 11 01 1 1 02 1 1 07 - <br /> 1 1 01 1 1 02 1 1 03 <br /> 1 1 01 1 1 02 ` ' 03_LI <br /> I I 01 1 1 02 1 1 OS I I I <br /> N 1 01 1 1 02 - 1 1 03 I I I I I I I I I I I I I <br /> IS CC'ITAINER LOCATED ON AN AGRICULTURAL FARM? 1 1 01 YES 1 1 02 NO <br /> MIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT. <br /> r c;0'. EIl IvO ISIGv♦.uPel PMONE Wi AR[A COD[ - l <br /> FOP LOCAL AGENCY USE ONLY 1I <br />•D-I -;•P°'''" ''[''_-` Ic[T) coo[ ICOUNlr CODE <br /> 12l I <br /> CO•.*ACT P[csnv PNONE W1.0f, coo[ <br /> ATI O• \A T IN vVT ION IN COMPLIANCE R[RMIT APPROVAL DAT[ TRANSACTION RITC LOCAL PERMIT f0 tl <br /> /S (0/ <br /> t— (— .� I I Cl01 .f s 1 0I NO - I <br /> SC04-0'118[[55 UUU 1 PAGE 2 <br />