COMPLIANCE INFO_1985-1999 - Laserfiche WebLink

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s 0 0 STATE ID NUMBER 00000011073003 CONTAINER CONSTRUCTION E. ( ) 01 RUBBER LINED ( 1 02 ALY.YO LINING t D 03 EPDXY LINING 1 ) 04 PHENOLIC LINING ( ) 05 GLASS LINING ( 1 07 UNLINED (X) 08 UNKNOWN t ) 09 OTHER: F. ( ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( D 05 NONE ( ) 06 TAR OR ASPHALT ( ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE t ) 02 CONCRETE-LINED TRENCH t ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION (X) 06 UNKNOWN ( ) 07 NONE B. UNDERGROUND PIPING: t l 01 DOUBLE-WALLED PIPE t ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE h/� 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE VII LEAK DETECTION (X) 01 VISUAL (X) 02 STOCK INVENTORY—( 1 04 VAPOR SNIFF WELLS t ) 05 SENSOR INSTRUMENT ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS ZF 'YOU C -CV!D YES 70 !V-F YC'J ARE NOT RECUIFEO TO COMPLETE THIS SECTION C'JPRENTLY a;E'.':OUSLY DELETE CASA (IF kNCWN) CHEMICAL (00 NOT USE CCMMEPCIAL NAME ) STCPED STCPED ( l 01 ( ) 02 ( ) 03 � ( 101 ( 102 0031111 ( il ( I1111 ( ) 01 ( 1 02 ( ) 03 I ( l 01 ( ) 02 ( D 03 1J11H t ) 01 ( 1 02 ( ) 03 1 III i t ) 01 ( D 02 ( D 03 � I ( ) 01 ( ) 02 l ) 03 ( 1 01 t ) 02 ( ) 03 ( ) 01 ( 1 02 ( ) 03 ( l 01 t l 02 ( ) 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 THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PSPSCN FILING (SIGNATURE) ---- -_- _- - -- PMCNE W/AREA CODE 1 FOR LOCAL AGENCY USE ONLY J ADMZN:STRAT:NG AGENCY CITY CODE COUNTY CODE CCNTACT =E=SCN IPMONE W/APEA COD! �i DATE OF LAST INSPECTION 1YN COMPLIANCE PERMIT APPRO\'Al DATE TRANSACTION DATE LOCAL PEPMZT '.D tt'— O1-YES- ( ) 02 NO —� - - -- HSC04-070185 (10/18/85) PAGE 2