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STATE ID NUMBER 00000030803002 <br /> CONTAINER CONSTRUCTION <br /> E. C ) Cl RUBBER LINED ( ) 02 ALKYD LINING f l 03 EPDXY LINING ( l 04 PHENOLIC LINING C ) 05 GLASS LINING <br /> f ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: <br /> F. d ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION ( } 04 UNKNOWN (XI 05 NONE <br /> ( k 06 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROU140 PIPING: t ) 01 DOUBLE-WALLED PIPE ( } 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) t ) 04 PRESSURE ( 1 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: f ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) (X) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> t ) 01 VISUAL (X) 02 STOCK INVENTORY t ] 04 VAPOR SNIFF WELLS C ) 05 SENSOR INSTRUMENT <br /> f 1 06 GROUND WATER MONITORING WELLS ( l 07 PRESSURE TEST ( ) 09 NONE e,(,) 10 OTHER. <br /> VIII CHEMICAL. COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO SV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CJP.PENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHtMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> ( ) 01 ( ) 02 f 1 03 <br /> ( } <br /> 01 ( l 02 ( ) 03 <br /> ( 1 <br /> 01 t l 02 ( ) 03 <br /> ( ) <br /> 01 C ) 02 ( ) 03 <br /> C 1 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> 01 ( ) 02 ( ) 03 <br /> f ) 01 i ) 02 ( ) 03 <br /> ( ) 01 C ) 02 ( ) 03 <br /> [ 1 O1 E ) 02 ( ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> I5 CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( 1 01 YES (X) 02 NO <br /> THIS FOR S EN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PEPS N F- NG GN PHONE W/AREA CODE <br /> 6a <br /> FOR LOCAL AGENCY SE ONLY <br /> ADMINISTRATING AGENCY CITY CODE FO <br /> NTY CODE <br /> cr � <br /> CONTACT PEFSON PHO W/AREA CODE <br /> Z' r ( —76 <br /> TRANSACTION DATE LOCAL PERMIT ID # <br /> DATE OF LAST INSPECTION IN COMPLIANCE REKNIT APPP.OVAL DATE <br /> ( 1 01 YES C i 02 NO <br /> 4SC04-070185 (10/18/85) PAGE 2 <br />