Laserfiche WebLink
�.. .: <br /> STATE ID NUMBER 00000013774002 <br /> CONTAINER CONSTRUCTION <br /> E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING f 1 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> ( ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: <br /> F. f ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING f 1 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( 1 05 NONE <br /> ( l 06 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE f ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( 1 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) Wn-04 PRESSURE (NQ 05 SUCTION f 1 06 UNKNOWN f 7 07 NONE <br /> VII LEAK DETECTION <br /> f ) 01 VISUAL (X) 02 STOCK INVENTORY f ) 04 VAPOR SNIFF WELLS ( 1 05 SENSOR INSTRUMENT <br /> '€ ( ) 06 GROUND WATER MONITORING WELLS ( 1 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU APE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> ( 1 <br /> 01 ( ) 02 ( 1 03 <br /> f ) Bl ( ) 02 ( ) 03 <br /> f 1 01 ( 1 02 w ( ) 03 <br /> f 1 01 ( ) 02 ( ) 03 <br /> f 1 Ol ( ) 02 ( ) 03 <br /> f 1 01 ( ) 02 f ) 03 -- <br /> ( ) Ol ( 102 f ) 03 <br /> ( 1 <br /> 01 ( 1 02 1 ) 03 <br /> ( ) <br /> 01 ( 1 02 ( l 03 <br /> f 101 ( ) 02 ( ) 03 <br /> • CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE'SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PER 50 FIL fSS TURN PK W/AREA CODE <br /> 20p -f-a-(?- Y//b <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMIN TRATING ENCY CITY E�j COUNTY CODE <br /> I!N / <br /> CONTAC P[RSON PH NE W/AREA CODE <br /> Qwl&0360� 2a <br /> DATE OF LAST INSPECTION IN COMPLIANC! PERMIT APPROVAL DAT! TRANSACTION DATE LOCAL PERMIT ID # <br /> ( ) OS YES t 1 OE NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br />