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Container Construction <br /> E. O of Rubber Lined O 02 Alkyd Lining ❑o3 Epoxy Lining O o+ Phenolic Lining ❑o* Glass Lining ❑oe Clay Lining <br /> 7 o, Unlined ❑oe Unknown o5 Other <br /> F. ❑of Polyethlene Wrap O o2 V)nyi Wrapping ❑o3 Cathodic Protection <br /> ❑o. Unknown ❑®o None O oD tar or asphalt O oe other. Fiberglass Reinforced <br /> Plastic <br /> VI Piping <br /> A. Aboveground Piping: ❑ of Double-walled pipe ❑ o2 Concrete-lined trench ❑ os Gravity ❑ oa Pressure ❑os Suction <br /> [(Check) appropriate box(es)-1 ❑ oe Unknown ❑ o7 None <br /> B. Underground Piping: Biot Double-walled pipe poi Concrete-lined trench ❑oa Gravity boa Pressure ❑ oD Suction <br /> [(Check) appropriate box(es)] ❑oe Unknown O 07 None <br /> VII Leak Detection <br /> ❑or Visual ❑o2 Stock Inventory ❑07 Tile Drain 0 o+Vapor Sniff Wells ❑os Sensor Instrument <br /> ❑oe Ground Water Monitoring We!;s O or Pressure Test ❑oe Internal Inspection ❑oe None <br /> ❑10 Other Continuous electronic monitoring <br /> VIII Chemical ComposlUon 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 seclton <br /> Peelawly cherMCa1 Do root use eomme c.ar name (use awit-owi paper lot more room <br /> stpre0 slpre0 CAS.(It known) <br /> ❑01 002 <br /> ❑01 ❑02 <br /> ❑01 ❑02 <br /> Is Container located on an Agricultural Farm? ❑o% Yes 02 No <br /> P n Fit'. g(Signator Pnone /area cooc <br /> For Local Agency Use Only <br /> AGENCY NA-C Ic"y <br /> 1COU.?T <br /> CONTACT PERSON PNONE w/AIIEA CODE <br /> INSPECTION DATE IIST INSPECTION) PERMIT APPROVAL DATE PERMIT ID. NUMBER <br /> FOR STATE USE ONLY <br /> STATE 1 O. NUMBER JACQOunl.nVQ NUn1Der Couray Number - <br /> Dale Rec"ea 001 (]0: 003 <br /> Majors Engineering, Inc. , 100 Park Plc. , #220, San Ramon, Ca., 94583 <br /> 415-820-2423 <br />