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0 46 CONTAINER CONSTRUCTION STATE ID NUMBER 00000011280001 E. ( ) 01 RUBBER LIMED ( 1 02 ALKYD LINING ( ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( ) 05 GLASS LINING ( 1 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: F• ( 1 01 POLYETHLENE WRAP ( 1 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( 1 05 NONE ( ) 06 TAR OR ASPHALT ( ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH f ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN (242 07 NONE B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE VII LEAK DETECTION WF- 01 VISUAL (X) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS f ) 05 SENSOR INSTRUMENT ( ) 06 GROUND WATER MONITORING WELLS (?C1' 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CAS, (IF KNOWN) STCRED STOPED CHEMICAL (00 NOT USE COMMERCIAL NAME) ( 1 01 ( ) 02 ( 1 03 ( ) Ol ( ) 02 ( 1 03 f ) 01 ( 1 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 ( ) Ol ( 1 02 ( ) 03 ( ) 01 ( 1 02 f ) 03 ( ) 01 ( 102 ( ) 03 ( ) 01 ( ) 02 ( ) 03 f ) 01 ( ) 02 ( ) 03 ( ) O1 ( ) 02 ( ) 03 +( CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO 'HIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PERSO MING (SIGNATU PHONE W/AREA CODE ��ll �(Jz� R LOCAL AGENCY USE ONLY 4OMINISTRATING AGENCY y1kt, '� � I CITY CODE COUNTY CODE )ONTACT PERSON '17` r arlK PHONE W/AREA CODE SATE OF LAST INSPECTION ;;4E2,4 02 NO PPROVAL DATE TRANSACTION DATELOCAL PERMIT IDC04-070185 (10/18/85) �` , PAGE 2 S