BILLING 1985-1999 - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER 00000012531001 CONTAINER CONSTRUCTION E. f D 01 RUBBER LINED ( ) 02 ALKYD LINING ( 1 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING (X) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER= F. C 1 01 POLYETHLENE WRAP ( 1 02 VINYL WRAPPING C ) 03 CATHODIC PROTECTION ( 1 04 UNKNOWN ( ) 05 NONE (X) 06 TAR OR ASPHALT t ) 09 OTHER= VI PIPING A. ABOVEGROUND PIPING: ( 1 01 DOUBLE—WALLED PIPE ( ) 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 ( 1 02 CONCRETE—LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE VII LEAK DETECTION ( ) 01 VISUAL (X) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT ( ) 06 GROUND WATER MONITORING WELLS (X) 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER= VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS .F YOU CHECKED YES TC IV-F YOU APE NOT REQUIPED TO COMPLETE THIS SECTION CUPPENTLY PRE%l:CUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STORED STCFED C ) 01 ( ) 02 ( 1 03 f ) 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 t ) 03 ( ) 01 ( ) 02 ( 1 03 01 t ) 02 f ) 03 t ) 01 t ) 02 ( ) 03 ( D 01 [ ) 02 f ) 03 d ) 01 ( D 02 t 1 03 C ) 01 ( ) 02 ( ) 03 [ D 01 i ) 02 C 1 03 CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS FISCONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO T THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY CF PERJURY ANDe TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PEPSON FILING (SIGNATURE) PHONE W/AREA CODE FOR LOCAL AGENCY USE ONLY A0MINIS7RATINO AGENCY CITY CODE COUNTY CODE CONTACT PERSON PHONE W/AREA CODE DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APP&OVAL DATE TRANSACTION DATE LOCAL PERMIT ID U ( ) D1 YES ( ) 02 NO PAGE 2 HSC04-070185 (10/18/85)