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0 9 <br /> STATE ID NUMBER 00000008382009 <br /> CONTAINER CONSTRUCTION <br /> E. ( 1 01 RUBBER LINED f ) 02 ALKYD LINING ( } 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> (X) 07 UNLINED ( 1 08 UNKNOWN ( ) 09 OTHER: <br /> F. ( ) OL POLYETHLENE WRAP i 1 02 VINYL WRAPPING ( l 03 CATHODIC PROTECTION ( ) 04 UNKNOWN {X) 05 NONE <br /> (Xl 06 TAR OR ASPHALT ( l 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) OI DOUBLE-WALLED PIPE ( l 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) i ) 04 PRESSURE ( ) 05 SUCTION (X) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: f } 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) { l 04 PRESSURE (X) 05 SUCTION ( } 06 UNKNOWN ( l 07 NONE <br /> VII LEAK DETECTION <br /> ( ) 01 VISUAL ( ) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( } 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> =F YOU CHECKED YES TO IV-F YOU P<< NOT PE001PED TO COMPLETE THIS SECTION <br /> CUPPENTLY PREVICUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DC NOT USE COMMERCIAL NAME) <br /> STOF_D STORED <br /> (X1 Ol ( ) 02 [ 1 03 SOLVENTS <br /> (X) 01 ( 1 02 { 1 03 PAINT THINNER <br /> ( ) 01 ( ) 02 ( l 03 <br /> f ) Ol ( l 02 ( ) 03 <br /> { l 01 ( ) 02 ( 1 03 <br /> { ) 02 ( ) 02 ( ) 03 <br /> ( ) 01 ( 1 02 1 1 03 <br /> ( l al ( ) 02 { l 03 <br /> ( } OI ( l 02 ( l 03 <br /> ( ) 01 ( l 02 ( 1 03 <br /> �( CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? f ) Cl YES (X) 02 140 <br /> THIS FORM HAS BEEN COMPLETED DER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNCWLEDGE, IS TRUE AND CORRECT. <br /> PEP.SOG (SI �TU PHOZ W/AAPEA COE <br /> yy[ D_'o <br /> FOR LOCAL AGE USE ONLY <br /> AOM:SISTRATING AGENCY CIT CCDE COUNTY CODE <br /> CONTACT PERSON ��� �� PHONE W/AREA <br /> DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # <br /> C ) 01 YES ( 1 02 NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br />