BILLING - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER 00000000955001 CONTAINER CONSTRUCTION E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING I ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: 01 POLYETHLENE WRAP ( 1 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( ) 05 NONE ( ) 06 TAR OR ASPHALT ( 1 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE l ] 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 5 SUCTION [ 1 06 UNKNOWN ( ) 07 NONE VII LEAK DETECTION '( ) O1 VISUAL ( 1 02 STOCK INVENTORY l ) 04 VAPOR SNIFF WELLS t ) 05 SENSOR INSTRUMENT ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STOPED STORED ( 1 01 [ ) 02 t ) 03 ( 1 0.1 ( )-02 ( ) 03 [ ) 01 [ 1 02 [ ) 03 ( 1 01 ( 1 02 ( 1 03 ( 1 01 ( 7 02 ( ) 03 ( ) 01 ( ) 02 ( 1 03 l l 01 ( 102 i l 03 ( ) 01 ( l 02 ( ) 03 ( 1 01 l l 02 ( ) 03 ( ) 01 ( 1 02 ( ) 03 CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS �IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO THIS FORM HAS BEEEff�fN COMPLETED UNDE E PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT, PERSON FILL � NATURE) PHONE W/AREA CODE l FOR LOCAL AGENCY USE ONLY ADMI NISTRATI NQ AGENCY �( / CITY_CCQE COUNTY CODE CONTACT PERSOW < �� 1 i � PHONE W/AR A COOL DATE OF LAST INSPECTION IN COMPLIA E PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID k ( ) O1 YES ( ) 02 NO IISC04-070185 (10/18/85) PAGE 2