Laserfiche WebLink
• STATE IO NUMBER 00000049917001 <br /> CONTAINER CONSTRUCTION <br /> E ( 7101 RUBBER LINED (X) 08 UNKNOWN LINING <br /> 09 OTHER: ON <br /> EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> 07 <br /> ED <br /> F ( 7(07 06LTARHLEE WRAP ORNASPHALT 1(7702 VINYLWRAPPINGf ) 03 CATHODIC PROTECTION fXl 04 UNKNOWN ( 7 05 NONE <br /> VI PIPING <br /> A. ABOVEGROUND PIPING [ 7 OS DOUBLE-WALLED PIPE ( ] 02 CONCRETE-LINED TRENCH ( 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE ( 1 05 SUCTION ( ) 06 UNKNOWN t l 07 NONE <br /> B. UNDERGROUND PIPING: ( 7 O1 DOUBLE-WALLED PIPE f 102 CONCRETE-LINED TRENCH ( 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOXIEST ( ] 04 PRESSURE lX) 05 SUCTION ( 1 06 UNKNOWN ( 1 07 NONE <br /> VII LEAK DETECTION <br /> ( ( 01INSTRUMENT <br /> 0VSUAL62 GROUND(X) 02 STOCK WATER MONITORING NWELLS t(7 D 07VPRESSUREFTESTAPOR SNIF WELL9 )(09 NONE05 SENSOR 10 OTHER: <br /> VIII HEMICLsOMPOSITIO COMPOSITION MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> YOU eDREQUIRED SECTION <br /> CURRENTLY PP.EVIOUSLY DELETE CAS)( (IF KNOWN) <br /> CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> f 1 Ol f%4 02 ( ) 03 <br /> a�A7r CI rzfo�)/l2 <br /> ( ) 01 ( 1 02 ( ) 03 <br /> t ) O1 ( 7 02 ( ) 03 <br /> ( ) 01 ( ] 02 ( ) 03 <br /> ( 7 <br /> 01 ( 7 02 ( ) 03 <br /> ( ) <br /> 01 ( 7 02 ( ) 03 <br /> ( 7 <br /> 01 t 7 02 ( ) 03 <br /> ( 7 01 ( 1 02 ( ) 03 <br /> ( 1 <br /> 01 ( 7 02 ( ) 03 <br /> ( ) <br /> 01 ( 1 02 ( 1 03 <br /> �t CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) O1 YES (Xi 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> HONE W/AREA CODE <br /> PEP.SON FILING (SIGNATURE) 1VI//l�._I» - <br /> PFORLOCAL AGENCY USE ONLY <br /> CITY CODE COUNTY CODE <br /> STRATING AGENCY <br /> PHONE W/AREA CODE <br /> T PERSON <br /> F LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE <br /> LOCAL PERMIT ID tt <br /> ( ) O1 YES ( 1 02 NO <br /> PAGE 2 <br /> KSC04-070185 (10/18/85) <br />