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6 0 <br /> STATE I0 NUMBER 00000065270002 <br /> CONTAINER CONSTRUCTION <br /> E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING t` ) 03 EPDXY LINING ( ) 04 PHENOLIC LIN ( ) 05 GLASS LINING <br /> ( ) 07 UNLINED ( )'08 UNKNOWN (X) 09 OTHER= RESIN EPDXY <br /> F. ( ) 01 POLYETHLENE WRAP t 1 02 VINYL WRAPPINGt ) 03CATHODICPROTECTION ( ) 04 UNKNOWN (X) 05 NONE <br /> ( ) 06 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE t ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: t ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) (X) 04 PRESSURE t ) 05 SUCTION ( ) 06 UNKNOWNt ) 07 NONE <br /> VII LEAK DETECTION <br /> ( ) 01 VISUAL (X) 02 STOCK INVENTORY t ? 04 VAPOR SNIFF WELLS (X) 05 SENSOR INSTRUMENT <br /> (X) 06 GROUND WATER MONITORING WELLS (X) 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) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> t ) <br /> 01 ( ) 02 ( ) 03 <br /> O <br /> 01 ( ) 02 ( 03 <br /> t ) 01 4 ) 02 ( ) 03 <br /> # ) 01 t ) 02 ( ) 03 <br /> t ) Ol ( ) 02 ( ) 03 <br /> ( ) 01 t ) 02 ( 1 03 <br /> t T 01 ( ) 02 ( 1 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 t 1 03 <br /> t ) 01 ( ) 02 ( ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAIN R LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> THIS FORM AS BEEN COMPLETEDUNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PERSON NO I NATURE) PHONE !AREA CODE <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMI STRATING GENCYpp / CITY CODE COUNTY CODE <br /> apz <br /> 0� <br /> CONT PERSON PHONE WlAREACE <br /> Ao <br /> GATE C}F LAST NSPECTION IN COMPl3ANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT 10 # <br /> // f! ( ) O1 YES t ) 08 NO <br /> HSC04-070185 (05/05/86) PAGE 2 <br />