COMPLIANCE INFO_1985-1996 - Laserfiche WebLink

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STATE ID NUMBER 00000031202003 CONTAINER CONSTRUCTION E. '( ) 01 RUBBER LINED t ? 02 ALKYD LINING t ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING t ) 05 GLASS LINING ( ) 07 UNLINED '(X) 08 UNKNOWN ( ) 09 OTHER: F. ( ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPFNG ( ) 03 CATHODIC PROTECTION ( ) 04 UNKNOWN (X) 05 NONE ( D 06 TAROR ASPHALT ( ) 09 OTHER: VI' PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( l 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 ( ) 02 CONCRETE-LINED TRENCH (X) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE VII LEAK DETECTION 01 VISUAL (X) 02 STOCK INVENTORY { } 04 VAPOR SNIFF WELLS t } 05 SENSOR INSTRUMENT t ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE t ) 10 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 ( l 01 ( ) 02 ( ) 03 ( } 01 ( ) 02 ( ) 03 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 (, ) 03 ( ) 01 ( ) 02 ( ) 03 (-1 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 { ) 01 ( ) 02 ( ) 03 ( l 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? f ') 01 YES (X) 02 -NO THIS FO HA BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BESTOFMY KNOWLEDGE, IS TRUE AND CORRECT. PER ON F I (SI RE) PHONE W/AREA CODE FOR LOCAL AGENO USE ONLY ADMINISTRATING AGENCY CITY CODE COUNTY CODE CONTACT PERSON PHONE W/AREA CODE el �L DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # ( ) 01 YES ( ) 02 NO HSC04-070185 (10/18/85) PAGE 2