Laserfiche WebLink
STATE ID NUMBER 00000008382004 <br /> CONTAINER CONSTRUCTION <br /> E. C ) 01 RUBBER LINED t ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( ) C4 PHENOLIC LINING ( ) 05 GLASS LINING <br /> (X) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: <br /> F. ( ) 01 POLYETHLENE WRAP I ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION ( } 04 UNKNOWN C ) 05 NONE <br /> (X) 06 TAR OR ASPHALT [ l 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: f ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOXCES) ( ) 04 PRESSURE ( ) 05 SUCTION (X) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE C ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( 1 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> C ) 01 VISUAL I ) 02 STOCK INVENTORY C l 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> i ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST CX) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU ARE NOT REC,UIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# fIF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME ) <br /> STCFED STC"r.ED <br /> (X) 01 C ) 02 f ) 031 1 1 1 *� 9 ETHYLENE GLYCOL MONOETHYL ETHER ACETATE (2-ETHOXYETHANOL ACE j <br /> l ) 01 ( ) 02 ( } 03 <br /> [ ) 01 ( ) 02 C ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 t ) 03 <br /> C ) 01 ( ) 02 t ) 03 <br /> ( l O1 C ) 02 ( } 03 <br /> C ) 01 ( ) 02 ( ) 03 <br /> ( ) 01 [ ) 02 ( } 03 <br /> ( ) 01 ( ) 02 ( 1 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED E PENALTY OF PERJURY AND, TO THE BEST OF MY KNO14LEDGEP IS TRUE AND CORRECT. <br /> PERSON F L W1111S_IGNAT E ) PHONE W/AREA CODE <br /> FOR LOCAL AGENCY ONLY <br /> ADMI ISTFATIG AGENCY CITY CODE COUNTY CODE <br /> 0 39 <br /> CONTACT PERSON PHO��W�.'�EA CODE <br /> q��`� 5`[ <br /> WC � '# <br /> DATE OF LAST INSFECTICN IN COMPLIANCE .4PPRO%'AL DATE TRANSACTION DATE LCCAL PERMIT IQ tt <br /> ( 3 01 YES ( 1 02 NO PERMIT <br /> HSC04-0701€5 (10/18/85) PAGE 2 <br />