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STATE ID NUMBER 00000060780001 <br /> CONTAINER CONSTRUCTION <br /> E. ( ) O1 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> (X) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER <br /> F. ( } O1 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING [ ) 03 CATHODIC PROTECTION t ) 04 UNKNOWN (X) 05 NONE <br /> ( ) O6 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING _ <br /> E,, GROUND PIPING: ( 1 O1 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( 1 03 GRAVITYK APPROPRIATE BOXES) [ ) 04 PRESSURE ( ) 05 SUCTION [ } 06 UNKNOWN ( ) 07 NONE <br /> GROUPROPIPING'BOX(ES) [ ( Q1040PRESSURELED PI05 SUCTION PE 02 C(ON)R06EUNKNOWNTRENCH <br /> 07(NbNE3 GRAVITY <br /> (CH <br /> CK <br /> RIATE <br /> VII LEAK DETECTION <br /> tF( 015I ( STOCK NOLVAPOR <br /> SNIFF LLS OOEEN(DINSTRUMENT <br /> 0 ) 07PRESSURETEST09 NONE <br /> N1OHER:� MONITORING <br /> VIII CHEMICAL ED YES COMPOSTO IV-F ITION OU APE F REQUIRED ID S SETEORED HITHIS SECTIONN UNDERGROUND CONTAINERS <br /> IF YOU <br /> FCUPPS;NTLY PREVi0U5LY D°LETS CAS# (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> STORED( ) 0 2 ( ) 03L - <br /> ( } 01 [ ) 02 ( 1 03 <br /> ( ) <br /> 01 [ ) 02 ( ) 03 <br /> 01 ( ) 02 t ) 03 <br /> t ) <br /> 01 F 1 02 [ 1 03 <br /> [ 1 <br /> 01 [ ) 02 ( 1 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> t } 01 [ ) 02 [ ) 03 <br /> ( ) 01 t l 02 ( ) 03 <br /> [ ) 01 ( ) 02 [ ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IiS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> THIS FORM HAS BEE14 COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PHONE WIAREA CO{DE f <br /> PEr54 FILi ' ( sN r,% <br /> FOR LOCAL AGENCY U ONLY <br /> CITY CODE FCOUN7YCODE <br /> ADMINISTRATING AGENCY <br /> PHONE W/AREA CODE <br /> CONTACT PEPSON <br /> TE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION OATH LOCAL PERMIT ID # <br /> ( ) O1 YES ( 1 02 NO <br /> PAGE 2 <br /> 070185 (10/18/85) <br />