Laserfiche WebLink
[. 1 I '01 RUBBER LIIIEO1 1 02 ALKYD LINING 1 1 03 EPDXY LINING 1 1 04 PHENOLIC LINING ( 1 05 GLASS LINING <br /> ---._ 1 I 07 U11LI11EO x) OB U11KHOWN 1 1 09 OTHER! <br /> 01 POLYETHLENE WRAP 1 1 02 VINYL WRAPPING 1 1 03 CATHODIC PROTECTION ?,-T 04 (RRKNOWN 1 1 05 NONE <br /> ( 1 06 TAR OR ASPHALT 1 1 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROL44D PIPING 1 1 01 DOUBLE-WALLED PIPE i 1 OL CONCRETE-LINED TRENCH ( 1 07 GRAVITY <br /> (CHECK APPROPRIATE BOXIEST l 1 04PRESSURE ( 1 OS SUCTION ( 1 06 UNKNOWN 07 NONE f <br /> B. LRKIERGROUINO PIPING: 1 1 O1 OOUOLE-WALLED IPE 1 ) 02 CONCRETE-LINED TRENCH 1 ) OS GRAVITY <br /> ICHECK APPROPRIATE BOXIEST ( 1 04 PRESSURE OS SUCTION ( 1 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> 1 1 91 VISUAL W 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS 1 1 05 SENSOR INSTRUMENT — -� <br /> 1 ) 06 GROUl0rWATER MOIIITORING WELLS 1 1 07 PRESSURE TEST 1 1 09 NONE 1 1 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> I/ TW CHECKED YES TO IV•I YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CVPSINTLY PREVIOUSLY DELETE CAS• IIF KNOWN) CHEMICAL 100 NOT USE COMMERCIAL NAME) <br /> STORCO STORED <br /> ( 101 ( 1 02 11031111111111111 <br /> 1 1 01 O 02 1 1 03 L I 1 I I I I I I i l I I <br /> 1 1 Ol ( 1 02 1 1 03 <br /> l I Ol 1 1 02 1 1 07 <br /> ( 101 1102 11 °31111111111111 <br /> ( 101 1 102 1103 <br /> 1 1 01 1102 ( ) 03 <br /> 1 01 1 02 <br /> ( 1 Ol ( 1 02 1 1 03 <br /> 1 1 01 t_1 D2_ <br /> T, 03 <br /> 1S CO:ITAIt1CR LOCATED ON AN AGR ICULTIN.AI FARM' ( 1 O1 T 1 1 02 NO - —� <br /> THIS FORM HAS BEEN COMPLETED IDER THE PEN T 0 P AND. TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> n ssoN Fn 140 1 vnon! W/AREA CODE <br /> All <br /> FOR LOCAL AGENCY SE 0 Y <br /> — - -- - <br /> a0-.1++1iTFaTING a.E I+CY CITY COOK COUNTY COD[ <br /> Lo ola c X15 - <br /> CON:ACT P.tSCN r <br /> PHONE W/AREA CODE <br /> o 9 6�6-7GJr6 <br /> DATE QOF LAST I ICTION IN COMF/IANCI---- —— PE.-IT APPROVAL DAY! TRANSACTION OAT! LOCAL PERMIT SO ■ <br /> ASC04-071185 <br /> PAGE 2 <br /> �� tir <br />