Laserfiche WebLink
CONTAINER CONSTRUCTION STATE ID NUMBER 00000036048004 <br /> E. ( 1 01 RUBBER LINED ( 1 02 ALKYD LINING ( ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING i ) 05 GLASS LINING <br /> ( ) 07 UNLINED (X1 08 UNKNOWN ( ) 09 OTHER: <br /> F. ( ) 01 POLYETHLENE WRAF ( J 02 VINYL WRAPPING i ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( 1 05 NONE <br /> i ) 06 TAR OR ASPHALT ( ) 09 OTHER; <br /> III PIPING <br /> A. ABOVEGROUND PIPING! ( ) 01 DOUBLE-WALLED PIPE [ ) 02 CONCRETE-LINED TRENCH t ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE f J 05 SUCTION ( ) 06 UNKNOWN f ) 07 NONE <br /> 8. UNDERGROUND PIPING: C ) pl DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( J 03 GRAVITY <br /> fCHEGK APPROPRIATE BDX[ESi C ) 04 PRESSURE t ) 05 SUCTION [X) p6 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> ( ) 01 VISUAL ( ) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS C J 05 SENSOR INSTRUMENT <br /> C J 06 GROUND WATER MONITORING WELLS ( 1 07 PRESSURE TEST fX) 09 NONE f ) 10 OTHER <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU ARE NOT PEGUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) <br /> CHEMICAL {DO NOT USE CCM("EPC;,4L NAME) <br /> STOPED STORED <br /> t ) 01 ( D 02 ( 1 03 <br /> [ 1 01 ( ) 02 ( D D3 <br /> [ ) OI f ) 02 ( l 03 <br /> ( 1 O1 ( 1 02 C ) 03 <br /> ( ) O1 f ) 02 ( 1 03 <br /> F J <br /> 01 ( 1 02 C 1 03 <br /> ( 1 01 t ) 02 ( ) 03 <br /> 02 f 1 03 <br /> f ) 01 ( J 02 ( ) 03 - <br /> ( J 01 ( ) 02 f ) 03 € I I I I I I f <br /> j' CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO - <br /> 1IS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT_ <br /> PERSON FILING (SIGNATURE) - - <br /> PHONE W>AREA CODE J <br /> :OR LOCAL AGENCY USE ONLY <br /> ...',INISTRATING AGENCY - -' <br /> CITY CODE COUNTY CODE <br /> CNTACT PERSON <br /> PHONE W/AREA CODE <br /> ATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # <br /> ( ) 01 YES ( )�02NO <br /> 04-070185 (10/18/85) <br /> PAGE 2 <br /> • <br />