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0 46 STATE ID NUMBER 00000038891003 <br /> CONTAINER CONSTRUCTION <br /> E. ( J 01 RUBBER LINED ( ) 02 ALKYD LINING f 103 EPDXY LINING ( ) 04 PHENOLIC LINING ( 1 05 GLASS LINING <br /> (X) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER' <br /> F. ( l 01 POLYETHLENE WRAP ( 1 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION ( 1 04 UNKNOWN ( 1 05 NONE <br /> (X) 06 TAR OR ASPHALT ( ) 09OTHER: <br /> VI PIPING <br /> A (CHECK APPROPRIATE BOX(ES) ( ( 0104 PRESSURELED )IPE 02 05 SUCTION C( )006EUNKNOWNINED TR`N) 07(NONE3 GRAVITY <br /> B. UNDERGROUNDAPPROPRIATEIPIG: BOXf ESI ( (X1104 PRESSURE LEU.P205 SUCTION CONCRETE-LINED 06UNKNOWNTREN'H 07(NONE <br /> 3 GRAVITY <br /> CK <br /> VII LEAK DETECTION <br /> ( ) <br /> 01 VISUAL (X) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 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 PREVIOUSLY DELETE CAS# (IF KNOWN) <br /> CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STOPED <br /> ( ) <br /> 01 (. ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ). 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 ( ) 03 - <br /> ( 1 <br /> 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( 1 02 ( ) 03 <br /> ( ) <br /> 01 ( l 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 ( ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FAR�( ) 1 YES CX)�NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PHONE W/AREA CODE <br /> PERSON IL ( I NATURE) O Z / <br /> ) <br /> FOR LOCAL AGENCY USE ONLY <br /> CITY CODE COUNTY CODE <br /> ADMINISTRATING AGENCY `c <br /> G AHON W/AREA CODE <br /> CONTACT PERSON <br /> DATE OF LAST INSPECT CN IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # <br /> ( ) O1 YES < ) 02 NO <br /> PAGE 2 <br /> KSC04-070185 (10/18/85) <br />