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• i STATE 10 NUMBER / <br /> CONTAINER CONSTRUCTION <br /> E. 1 Vol RUBBER LINED I 1 02 ALKYO LINING t 1 03 EPDXY LINING 1 1 04 'PHENOLIC LINING i 1 05 GLASS LINING <br /> I 1 07 UNLIPIED 1 1'08 LRIKNOWN ( 1 09 OTHER: <br /> ►. ( 1 01 POLYETHLENE WRAP 1 1 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION 1< 04 LRRCNOWN { 1 05 NONE <br /> 1 1 06 TAR OR ASPHALT 1 1 09 OTHER: <br /> VI PIPING <br /> A. A8OVEGROUhfD PIPING: [ 1 01 DOUBLE-WALLED PIPE ( 1 02 CONCRETE•LINED TRENCH I 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) 1 ) 04' PRESSURE I 1 OS SUCTION r 1 06 UNKNOWN [ 1 07 NONE <br /> S. UAIDERGROU111D PIPING: 1 1 01 DOUBLE-WALLE PPE ! 1 OZ CONCRETE-LINED TRENCH I 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOXIEST 1 1 04 PRESSURE t 05 SUCTION 1 1 06 UNKNOWN 1 1 07 NONE f <br /> VII LEAK DETECTION <br /> 1 1 01 VISUAL '[�1 02 STOCK INVENTORY ( 1 04 VAPOR "TIFF WELLS 1 1 05 SENSOR INSTRUMENT <br /> [ 1 OE GP.OLRID WATER MOFIITORING WELLS ( 1 07 PRESSURE TEST ( 1 09 NONE ( 1 10 OTHER: <br /> VIII C14EMICAL COMPOSITION Of MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-f YOU APC NOT REQUIRED TO COMPLETE THIS SECTION <br /> CUPrtNTLY PREVIOUSLY DELETE CASK fIC KNOWN) CHEMICAL SDO NOT USE COMMERCIAL NAME ) <br /> ITOCEO STORED <br /> t 1 01 [ I 02 <br /> v(t <br /> 01 [ 102 1103fIl�lllllll ' <br /> 01 ( 1 02 10301 ( r 02 <br /> 01 1 f 02 (_1 03 I _ <br /> { 1 Oi 1 1 02 ( 1 03 <br /> ( 1 O1 1 1 02 + i 0 <br /> 3 ' <br /> 1 1 01 l 1 02—{_1 03 LI 1LI —� <br /> [ I o1 1 1 02 1 1 113 <br /> s ! 01 1 1 02 1 1 03 <br /> ------ AN A RICULTLfPAI FARM? t 1 01 YES 1 1 02 NO — -�--- -----__�-----� _� <br /> 1S CC'ITAINE LOCATED ON G <br /> His FOR A EN *10 LETED LRIDER THE P AL OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> e_.c;0•+ Il IG F PH NC W/ARC► DC <br /> Zoe <br /> OP, L AGENCY USE ONLY <br /> •'J'[�+:5' n%T KDY .y.CIT1 CODE �COUNT� CODE <br /> PHONE W/AREA CODE <br /> ATC O• LAST INSCCCTION IN COMO LIANCE PERMIT APPROVAI DATE TRANSACTION DATE LOCAL PERMIT ID ■ <br /> PAGE 2 <br /> SCOa-071185 <br />