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. STATE ID NUMBER 00000019809001 <br /> CONTAINER CONSTRUCTION <br /> E( ) <br /> RUBBERILINEDf ) OB UNKNOWNLININD9 OTHER3 EPDXY LINING ( 1 04 PHENOLIC LINING ( ] 05 GLASS LININol <br /> 07 <br /> 07 UN <br /> I-YL <br /> OfiLTARHORNASPHALT (())009VOTHERWRA13PING ( ] 03 CATHODIC PROTECTION ( ) 04 UNKNOWN ( ) 05 NONE <br /> 01 <br /> VI PIPING <br /> A. ABOVEGROUND PIPING, ( ) al DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH 1 ) 03 GRAVITY <br /> URE 05 <br /> (CHECK APPROPRIATE BOX(ES) ( () 01000UBLES WALLED PIPE S(( )I 02 CONCRETE-LINED TRENCH N 06 UNKNOWN 07 <br /> 1OW-- <br /> 01 <br /> 3 GRAVITY <br /> NE <br /> B. UNDERGROUND PIPING <br /> (CHECK APPROPRIATE BOY( <br /> ( ) 04 PRESSURE (X7 tl5 SUCTION ( ) 06 UNKNOWN ( ) 07 NO <br /> rVII LEAK DETECTION05 <br /> ( 010VIGROUNOSUAL (X) 02 STOCKMONITINVENRING WE)RYLLS (())007V PRESSUREAPOR S� E TESTEES )(09 NONE INSTRUMENT <br /> MATERIALS NDERGROUND CONTAINERS <br /> COMPOSITION OF SORED IN U <br /> VIiFcHEMcCALs RETIC <br /> YOU EDD <br /> CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> CUPRENTLY PP.EVIOUSLY DELETE OAS# (IF KNOWN) <br /> STOPED STOPED <br /> ( ) <br /> 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( 1 02 ( ) 03 <br /> ( ) 01 ( 1 02 ( 1 03 <br /> ( ) 01 ( 1 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 f ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( 1 01 f ) 02 ( ) 03 <br /> ( 1 <br /> 01 ( ) 02 ( ) 03 <br /> ( ) <br /> 01 { ) 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 ( 1 03 <br /> it CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) Ol YES (X) 02 NO <br /> IS TRUE AND CORRECT. <br /> THIS FORM HAS EN OMPLETED NDER THE PENALTY OF PERJURY AND, TO THE BEST OF WMYAR KNOWLEDGE <br /> PHONE <br /> > <br /> A DO <br /> PE ON FILIN T ) <br /> FOR LOCA AGENCY U E ONLY CITY CODE COUNTY CODE <br /> ADMINISTRATING ENCY / G <br /> PHO E W/A EA CODE` <br /> CONTACT RSON <br /> TRANSACTION DATE LOCAL PERMIT ID 0 <br /> DATE OF LAST INSPECTION IN COMPLIANCE <br /> PERMIT APPROVAL DATE( ) 02 NO <br /> PAGE <br /> HSC04-070185 (10/18/85) <br /> i <br />