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Container Construction <br /> E. 0 o+ Rubber Lined O oa Alkyd Lining ❑os Epoxy Lining ❑a Phenolic Lining O o� Glass Lining ❑ob Clay Lining <br /> It!0, Unlined ❑oa Unknown 2 o9 Other <br /> F. ❑al Polyethlene Wrap O o: Vinyl Wrapping ❑03 Cathodic Protection <br /> ❑oA Unknown ❑as None O oo tar or asphalt ❑oe other- Fiberglass Reinforced <br /> VI Piping Plastic <br /> A. Aboveground Piping: ❑ of Double-walled pipe ❑ oz Concrete-lined trench ❑ as Gravity ❑ OA Pressure ❑os Suction <br /> [(Check) appropriate box(es)] ❑ o0 Unknown ❑ o7 None <br /> E4. Underground Piping: M1 Double-walled pipe poi Concrete-lined trench ❑o3 Gravity J§oA Pressure ❑ as Suction <br /> [(Check) appropriate box(es)] ❑oe Unknown O o7 None <br /> VII Leak Detection <br /> O or Visual ❑oz Stock Inventory ❑o3 Tile Drain O o.Vapor Sniff Wells O as Sensor Instrument <br /> O oe Ground Water Monitoring We::s O or Pressure Test ❑of Internal Inspection ❑os None <br /> ❑soother Continuous electronic monitoring <br /> VIII Chemical Composition of Materials Currently or Previously Stored In Underground Containers <br /> It you checked yes to IV-F you a•e not required to complete this secllon <br /> w ler Ily PraV--IY CMa+bal Do Nov use Comme ual Name fuse am-f-onal 0a0cr la move room <br /> sloreo staea CAS a(il known) <br /> 0o Ooz I <br /> ❑o) ❑0a <br /> ❑of ❑oa <br /> Is Container located on an Agricultural Farm? ❑o1 Yes b oz No <br /> P n Fifi (Signatur Phone wrarea Coac <br /> 1 <br /> For Local Agency Use Only <br /> AGENCY NAM[ irl- <br /> COUNTY <br /> CONTACT PCRSON LONE <br /> w/ANCA COOL <br /> INSPECTION DATE tIST INSPECTION) PERMIT APPROVAL DATE PERMIT 10. NUMBER <br /> FOR STATE USE ONLY <br /> STATE 10. NUMBER JAC,-,",ng NumOV CoumV NumOm <br /> Dale Aece,.eo 00, O o: 003 <br /> Majors Engineering, Inc. , 100 Park Plc. , #220, San Ramon, Ca. 94583 <br /> 415-820-2423 <br />