COMPLIANCE INFO_1985-1997 - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER 00000012412003 CONTAINER CONSTRUCTION E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING t 104 PHENOLIC LINING t )' 05 GLASS LINING (X) 07 UNLINED ( ) 08 UNKNOWN E D 09 OTHER: F. ) 01 POLYETHLENE WRAP C D 02 VINYL WRAPPING ( )-03 CATHODIC PROTECTION -(X) 04 UNKNOWN ( l-'05 NONE E l "06 TAR OR ASPHALT ( ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: t ) 0<1 DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE, ( l 05 SUCTION { ) 06 UNKNOWN t D 07 NONE B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLEO PIPE ( 1 02 CONCRETE-LINED TRENCH t ) 03 GRAVITY (CHECK APPROPRIATE 80X(ES) (X) 04 PRESSURE` E l 05 SUCTION t ).O6 UNKNOWN t ) 07 NONE VII LEAK DETECTION 01 VISUAL -(X) 02 STOCK INVENTORY f ] 04 VAPOR SNIFF WELLS (- ) 05 SENSOR INSTRUMENT f ) 06 GROUND WATER MONITORING WELLS f D 07 PRESSURE TEST f ) 09 NONE (X) 10 OCHER: LEAK DETECTOR VIII C.HEMIC,AL CO- POSITION OF MATERIALS STORED IN U D£RGRO.U'N-D CONTAINERS FF YOU CHECKED YES TO IV-F YOU ARE NOT REgUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CA'S# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STORED STORED f ) 01 t ) 02 ( ) 03 G :) 01 ( ) 02 ( ) 03 �D 01 ( ) 02 ( ) 03 t ) 01 ( ) 02 ( ) 03 03 ( ) 02 t: ) 03 t ) 01 ( ) 02 ( ) 03 t ) 01 - ( ) 02 ( ) 03 f ) Ol t ) 02 t ) 03 ( ) 01 E ) 02 f ) 03 t 3, 01 t ) 02 t ) 03 * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE STNONYt4s, IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? L ) 01 YES (X) 02 NO THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND;, TO THE ST OF MY ,KNOWLEDGE, IS TRUE AND CORRECT. PERSONAILING (.SIGNATU.RE) , PHONE W/AREA CODE FOR LOCAL AGENCY USE ONLY ADMINISTRATING AO*NCY CITY CODE COUNTY CODE &�rtlna- CONTA; PERSON _1P ;NE WlAREA CODE 1061 F-EA) DATE OF LAST INSPECTIONJIN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # ( ) 01 YES ( ) 02 NO HSC04-070185 (10/16/85) PAGE 2