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CONTAINER CONSTRUCTION STATE ID NUMBER 00000004169008 <br /> EEc) <br /> NED ( ) 02 ALKYD LINING [ ) 03 EPDXY LINING ( ] 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> ED (X) 08 UNKNOWN ( ) 09 OTHER:NE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( ) 05 NONE <br /> ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> FAABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN f ) 07 NONE <br /> UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH (X) 03 GRAVITY <br /> CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE [ 105 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> ( l <br /> 01 VISUAL J29.92 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS j"4 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS 04-07 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 ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> ( ) 01 ( ) 02 ( ) 03 <br /> f ) 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( 1 02 ( ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> l ) 01 ( ) 02 ( ) 03 <br /> f ) 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> f ) el ( ) 02 ( 1 03 - <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ■ <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 N COMPLETED UNDE HE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PERS FI NG (SIGNATURE) PHONE W/ RCA ODE <br /> FOR LOCAL AGENCY USE ONLY <br /> AOMINS STRATI NO AGENCY CITY CODDEE� COUNTY CODE <br /> CONTACT PER SCN PHONE W/AREA CODE <br /> Gy l <br /> DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DAT! LOCAL ►[KNIT ID # <br /> ( 1 <br /> 01 YES ( 1 03 NO <br /> NSC04-070185 (10/18/85) PAGE 2 <br /> 1� <br />