Laserfiche WebLink
�. .. <br /> STATE ID NUMBER 00000064663002 <br /> CONTAINER CONSTRUCTION <br /> E. f 1 01 RUBBER LINED ( ) 02 ALKYD LINING ( 1 03 EPDXY LINING ( 1 04 PHENOLIC LINING 1 ) 05 GLASS LINING <br /> ( ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: <br /> F. f 1 01 POLYETHLENE WRAP f l 02 VINYL WRAPPING f 1 03 CATHODIC PROTECTION 1X1 04 UNKNOWN l 1 05 NONE <br /> ( ) 06 TAR OR ASPHALT ( ) 09 OTHER= <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING= ( ) 01 DOUBLE-WALL€D PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE 05 SUCTION ( ) 06 UNKNOWN f ) 07 NONE <br /> VII LEAK DETECTION <br /> f 1 <br /> 01 VISUAL f 1 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( 1 05 SENSOR INSTRUMENT _ <br /> ( 1 06 GROUND WATER MONITORING WELLS f 1 07 PRESSURE TEST H(i'09 NONE ( 10 OTHER �PSTIf:F� <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> (X) 01 ( 1 02 ( ) 03 SOLVENTS Te <br /> ( I <br /> al f 102 ( ) 03 <br /> f ) Ol ( ) 02 ( ) 03 <br /> ( 1 01 ( l 02 ( ) 03 <br /> l 1 <br /> al l ) 02 ( ) 03 <br /> l 1 <br /> 01 ( 1 02 ( ) 03 <br /> ( 1 <br /> 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( l 01 ( 102 ( 1 03 <br /> ( ) <br /> 03 f 102 ( ) 03 <br /> ■ CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AH AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OFPERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PERSON FILING (SIGNATURE) PHONE W/AREA CODE <br /> Y /lQ <br /> FOR LOCAL AGENCY USE ONLY <br /> AOMI NISTRA TI;� F NCY 'C ITV CODE COUNTY COO[ <br /> JAJ <br /> CONTAC PERSON P HE W)AREA COD[Zry� <br /> (O / <br /> DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL OAT[ TRANSACTION DAT[ LOCAL PERMIT IO # <br /> ( ) 01 VES ( ) 02 NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br />