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STATE ID NUMBER 00000049155003 <br /> CONTAINER CONSTRUCTION <br /> E, ( } O1 RUBBER LINED t ) 02 ALKYD LINING ( 1 03 EPDXY LINING [ D 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> (X) 07 UNLINED t ) 08 UNKNOWN ( ) 09 OTHER' <br /> F. ( a 01 POLYETHLENE WRAP c D 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION ( 1 04 UNKNOWN S ) 05 NONE <br /> (X) 06 TAR OR ASPHALT t 1 09 OTHER: _ <br /> VI PIPING _ <br /> A. ABOVEGROUND PIPING= ( 1 01 DOUBLE-WALLED PIPE ( D 02 CONCRETE-LIN€D TRENCH ( } 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION (X) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING' ( 1 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( a 05 SUCTION ( 1 C6 UNKNOWN ( a 07 NONE <br /> VII LEAK DETECTION <br /> ( l 01 VISUAL ( ) 02 STOCK INVENTORY i 1 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER' <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 PREVICUSLY DELETE CASU (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> (X) 01 ( ) 02 ( ) 03 jj HYDRAULIC OIL <br /> ( 1 01 ( ) 02 ( D 03 <br /> ( a 01 ( ) 02 ( ) 03 <br /> ( 1 01 ( ) 02 C 1 03 <br /> ( ) 01 [ 1 02 ( 1 03 <br /> f ) 01 ( ) 02 ( 1 03 <br /> t ) 01 c ) 02 ( a 03 <br /> ( D 01 C a 02 ( 1 03 <br /> ( ) 01 [ ) 02 ( ) 03 <br /> ( <br /> _) 01- <br /> ( ) 02 4 ) 03 <br /> * CHECK STATE BOARD CHEMICAL CODE LISTING FOR PCSSIBLE SYNONYMS <br /> FCONTAINER LOCATEDON AN AGRICULTURAL FARM? (X) 01 YES ( a 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE9 IS TRUE AND CORRECT. <br /> PERSON FILING (SIGN.ATURE) PHONE W/.AREA CODE <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTPATIN3 AGENCY CITY CODE CCUNTi' CODE <br /> CONTACT PERSON PHONE W/AREA CODE <br /> DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT <br /> ( ) O1 YES ( 1 D2 NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br /> b <br /> r i <br />