Laserfiche WebLink
• • STATE I0 NUMBER 00000010517002 <br /> CONTAINER CONSTRUCTION <br /> E ( 71X1 RU01 BBER UNLINED <br /> 1 08 UNKNOWN LINING <br /> 09 OTHER: <br /> EPDXY LINING <br /> ( ) 04 PHENOLIC LINING f ) 05 GLASS LIMING <br /> F. ( ) 01 POLYETHLENE WRAP f 1 02 VINYL WRAPPING f ) 03 CATHODIC PROTECTION f 1 04 UNKNOWN ( ) 05 NONE <br /> (X) 06 TAR OR ASPHALT ( 1 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND <br /> APPROPRIATE•BOX(E57 ( ( 0104 PRESSURE LED 7305 SUCTION PE 02 CO(X)R 06EUNKNOWNTRiN;N07(NONE3 GRAVITY <br /> B UNDERGROUND <br /> APPROPRIATE f f 03040 PRESSURE LED P3PE 05 SUCTION CON)R 06EUNKNOWNTR ENON07(NONE3 GRAVITY <br /> VII LEAK DETECTION <br /> 05 <br /> ( ` 01VSUAL063 GROUND(WATER MONITORING X) 02 STOCK NTORYWELLS ((7)007VAPOR PRESSURE TESTLLS )f 09 NONEEN( ) NST10 OTUMENT <br /> HER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) <br /> CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> ( ) 01 ( ) 02 ( 1 03 iY ) <br /> f 1 01 I ) 02 ( ) 03 <br /> ( ) 01 ( l 02 ( 1 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( 7 Ol ( ) 02 ( ) 03 <br /> ( ) Ol ( 102 ( ) 03 <br /> ( ) <br /> 01 f 7 02 ( ) 03 <br /> ( ) 01 ( 7 02 ( ) 03 <br /> ( 7 <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 <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PERSON FILING (SIGNATURE) PH E WARE CODE�"lQKn1 p1 IL <br /> FOR LOCAL AGENCY USE ONLY <br /> 1 C Y E COUNTY CODE <br /> ADMINISTRATING AGENCY <br /> 1 ,11 \ b ) CQ�`� PnACRE coo <br /> CONTAC ER50 <br /> " PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # <br /> DATE OF LAST INSPECTION IN COM LANCE <br /> ( ) 01 YES ( ) 02 NO <br /> PAGE 2 <br /> HSC04-070185 (10/18/85) <br />