Laserfiche WebLink
STATE ID NUMBER 000000124.12001 <br /> ,CO-NTAINE'R CONSTRUCTION <br /> E. ( ) 01 RUBBER LINED ( } 02 ALKYD LINING ( ) 03 EPDXY LINING t ) 04 PHENOLIC LINING t ) 05 GLASS LINING <br /> (X) 07 UNLINED ( ) 08 UNKNOWN t D 09 OTHER: <br /> F. f ) 01 POLYETHLENE WRAP t ) 02 VINYL WRAPPING ( ) 03 CATHODIC .PROTECTION (X) 04 UNKNOWN E ) 05 NONE <br /> ( ) 06 TAR OR ASPHALT 4 } 04 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PT.PING: t ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH (_ ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ): 04 PRESSURE A ) 05 SUCTION ( -) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: t ) 01 DOUBLE-WALLED PIPE t ) `02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOXES) (X) 04 PRESSURE t ) 05 SUCTION ( l 06 UNKNOWN f I- 07 NONE <br /> VII LEAK DETECTION <br /> 01 VISUAL (X) 02 STOCK INVENTORY t 3 '04 VAPOR SNIFF WELLS t ) 05 SENSOR INSTRUMENT <br /> II-wilr) 06 GROUND WATER MONITORING WELLS 4' ) 07 PRESSURE TEST t ) 09 NONE (X) 10 OTHER: LEAK DETECT( <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IFYOU CHECKED YES 70 IV-F YOU APE NOT RE�UI"R-ED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE GAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> ( ) 01 ( ) 02 G ) 03 <br /> t ) 01 ( ) 02 t ) 03 <br /> 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) :02 ( ) 03 <br /> (- ), 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) '02 ( ) 03 <br /> ) 01 ( ) 02 ( ) 03 <br /> t ) 01 ( ) 02 ( ) 03 <br /> ) 01 ( ) 02 ( ) 03 <br /> t ) 01 ( ) 0.2 ( ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? t ) 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN C014PLETED UNDER THE PENALTY OF PERJURY ANOP TO THE BEST OF MY KNOWLEOGEi IS TRUE AND CORRECT. <br /> PERSON "LING (SIGNATURE) P}1ONE W/AR;EA CODE <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINIST*ATY_G AGENCY CITY CODE COUNTY CODE <br /> CONTACT PERSON PHONE W/APER CODE <br /> R-a <br /> 51) <br /> DATE Of LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ZD # <br /> ( ) OZ YES ( ) 02 NO <br /> HSC04-070185 (1001$!853 PAGE 2 <br />