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60STATEID NUMBER 0000004213AO08 <br /> CONTAINER CONSTRUCTION <br /> E. ( l 01 RUBBER LINED ( ) 02 ALKYD LINING (X) 03 EPDXY LINING ( 1 04 PHENOLIC LINING t ) 05 GLASS LINING <br /> t ) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: <br /> F. ( l 01 POLYETHLENE WRAP t l 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN t 1 05 NONE <br /> t ) 06 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE—WALLED PIPE ( ) 02 CCNCRETE—LINED TRENCH [ l 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> S. UNDERGROUND PIPING: ( l 01 ODUBLE—WALLED PIPE ( ) 02 CONCRETE—LINED TRENCH ( d 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( l 04 PRESSURE (X) 05 SUCTION i ) 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> (Xd 01 VISUAL (X) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS t ) 05 SENSOR INSTRUMENT <br /> i d 06 GROUND WATER MCNITORING WELLS ( ) 07 PRESSURE TEST <br /> ( 1 04 NONE ( l 10 OTHER <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YCU CHECKED YES TO IV—F YOU APE NOT REQUIRED TO COMPLETE THIS SECTION <br /> — 1 <br /> CUPPENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> (X) 01 i 1 02 f ) 03 7 8 9 3 3 1 1 1 1 1 1 * METHYL ETHYL KETONE (2—BUTANONE) <br /> ( ! 01 ( ) 02 ( l 03 <br /> ( ) 01 { 1 02 i ) 03 <br /> ( ) 01 t d 02 ( ) 03 <br /> t ) 01 ( ) 02 { ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( 3 01 ( d 02 ( ) 03 <br /> ( ) 01 ( ) 02 f ) 03 <br /> ( ) 01 ( 1 02 ( d 03 <br /> ( ) 01 f ) 02 ( ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO y <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PEP.JURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PERSON FILING (SIGNATURE ) PHONE W/AREA CODE <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTRATING AGENCY CITY CODE COUNTY CODE <br /> CONTACT PERSON PHONE W/AREA CODE <br /> DATE OF LAST INSPECTION IN COMPLIANC�Z� <br /> JPERMIT APPROVAL DATE TRANSACTION DATE JLCCALPEPMIT ID it <br /> i ! O1 YES <br /> HSC04-070'185 (10/18/85) PAGE 2 <br />