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0 <br /> STATE ID NUMBER 00000008382002 <br /> CONTAINER CONSTRUCTION <br /> E. ( ) 01 RUBBER LINEA ( ) 02 ALKYD LINING ( } 03 EPDXY LINING i } 04 PHENOLIC LINING ( 1 05 GLASS LINING <br /> (X) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER= <br /> F. ( ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION f ) 04 UNKNOWN ( ) 05 NONE <br /> (X) 06 TAR OR ASPHALT f ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION (X) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( l 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( ) 06 UNKNOWN C ) 07 NONE <br /> VII LEAK DETECTION <br /> ( ) 01 VISUAL ( ) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> i 1 06 GROUND WATER MONITORING WELLS l ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU APE NOT REgUIRED TO COMPLETE THIS SECTION <br /> CUPPENTLY PFEVICUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STOPED STOPED <br /> (X) 01 ( 1 02 f ) 03 17181913131 * METHYL ETHYL KETONE (2-BUTANONE) <br /> ( I O1 ( ) 02 ( } 03 <br /> f ) 01 ( 1 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( 1 01 ( ) 02 f } 03 <br /> ( ) 01 ( ) 02 € 1 03 <br /> i ) 01 f ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( } <br /> 01 ( 1 02 f ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( } 01 YES (X) C2 NO <br /> THIS FORM HAS BEEN COMPLETED HE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, 15 TRUE AND CORRECT. <br /> PE P,SO'r L G�(SIG "El PHCNE k/AREA CODE <br /> FOR LOCAL AGENC SE ONLY <br /> AOMINISTR.ATIN^ AGENCY CITY CODE COUNTY CODE <br /> 37 1 <br /> CCNTAC) PEP ON PHCNEW�P A CODE r 'S <br /> DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTICN DATE LOCAL PEP.M17 ID # <br /> ( ) 01 YES f T 02 NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br />