COMPLIANCE INFO_1986-1996 - Laserfiche WebLink

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STATE ID NUMBER 00000062518002 CONTAINER CONSTRUCTION E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING t ) 04 :PHENOLIC LINING, ( ) 05 GLASS LINING tX)-07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: F. ( ) 01 POLYETHLENE WRAP 4 ) 02 VINYL WRAPPINGS (X) =03 CATHODIC PROTECTION t ) 04 UNKNOWN ( ) 05 NONE ( ) 06 TAR OR ASPHALT ( l '09 OTHER; VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-ktA.LLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (''CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( 07 NONE B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE C ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE S;.05 SUCTION ( ) 06 UNKNOWN% ( ) 07 NONE VII LEAK DETECTION ( 3 01 VISUAL (X) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT 06 GROUND WATER MONITORING WELLS .(>Q 07 PRESSURE TEST t ) 09 NONE ( ) -10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIPED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) STORED STORED t 'l" 01 t ) `02 ( ) 03 L ) 01 ( ) 02 ( ) 03 ( ) 01 ( } 02 ( ) 03 ( ) 01 ( l 02 ( l 03 t ) 01 ( ) 02 ( ) 03, 101 ( ) 02 ( ) 03 ( l 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 ( ) 01 t I 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 KNOWLEDGEt IS TRUE AND CORRECT. PERSON FL`II G (SIGNATU' PHONE W/AREA CODE 7 lc:)4�o FOR LOCAL AGENCY USE ONLY AOMINISTRATING .AGENCY CITY CODE COUNTY CODE rlk. 13 CONTACT PEPSOIV PHONE W/AREA CODE Cla- DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # 3s,-3 -a ( ) 01 YES ( ) 02 NO HSC04-070185 (10/18/85) ` PAGE 2