BILLING 1986-1988 - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER 00000009875003 CONTAINER CONSTRUCTION rE. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING f 1 04 PHENOLIC LINING ( 1 05 GLASS LINING (X) 07 UNLINED ( ) OS UNKNOWN ( ) 09 OTHER: F. f ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION f ) 04 UNKNOWN (X) 05 NONE ( ) 06 TAR OR ASPHALT ( ) 09 OTHER: VI PIPING ` A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY 1 (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE VII LEAK DETECTION '( ) 01 VISUAL (X) 02 STOCK INVENTORY f 1 04 VAPOR SNIFF WELLS f ) 05 SENSOR INSTRUMENT ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE ( ) 30 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STORED STORED ( ) 01 ( ) 02 ( ) 03 [ l 01 ( ) 02 ( ) 03 ( 1 01 ( ) 02 ( ) 03 l 7 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 f 1 01 ( ) 02 ( ) 03 ( ) 01 ( 102 ( ) 03 ( ) 01 ( l 02 ( 1 03 ( ) 01 ( 7 02 ( 1 03 ( 7 01 ( 1 02 ( 3 03 • CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO THIS FORM HAS BEEN COMPLETED UNDER E ENALTY OF PERJURY AND. .TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PERSON FILING (SIGN PHONE W/AREA CODE Ze 838 - FOR LOCAL ADEN Y USE ONLY ADMIN STRATING AGENCY D' s- CY CITY CODE COUNTY CODE S{Ao✓ j0AG�U) N Laces � �FI-c.T EJ CONTACT PERSO PHONE W/AREA CODE v, P c A-r1 Zo _ 838-73 / DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION D.ATEE LOCAL PERMIT ID # 1- _g ( ) 01 YES ( ) 02 NO KSC04-070185 (10/18/85) PAGE 2