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STATE IO NUMBER <br /> CONTAINER CONSTRUCTION <br /> E. 1 1 01 RUBBER LINED ( ) 02 ALKYO LINING 1 ) 03 EPDXY LINING l ) 04 PHENOLIC LINING ( 1 05 GLASS LINING <br /> 1 1 07 UNLINED (XI OB UNKNOWN ( 1 09 OTHER= <br /> F. l , 01 POLYETHLENE WRAP 1 1 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UO0NOW11 l ) 05 NONE <br /> 1 1 06 TAR OR ASPHALT ( l 09 OTHER- <br /> VI PIPING <br /> A. ABOVEGP.OLR40 PIPIN: 1 1 01 DOUBLE-WALLED PIPE 1 1 02 CONCRETE-LINED TRENCH 1 1 03 GRAVITY <br /> (CHECK AFFROPRIATE BOXIESI 1 1 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 LANE <br /> S. LRIDERGRCUND PIPING- I ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH 1 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PPESSURE l ) 05 SUCTION (X) 06 UNKNOWN l ) 07 NONE <br /> VII LEAK DETECTION <br /> 1 1 01 VISUAL l 1 02 STOCK INVENTORY 1 1 04 VAPOR SNIFF WELLS 1 1 05 SENSOR INSTRUMENT <br /> 1 1 06 GP,GNA NATER MOIIIIORING WELLS l 1 07 PRESSURE TEST (X ) 09 NONE f l 10 OTHER- <br /> VIII •CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU [NECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CUPPf NTLY PREVIOUSLY DELETE CASK IIF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> 1_1 Ol 1 1 02 ( ) 03 I I I <br /> I ) 01 l ) 02 ( ) 03L11 <br /> 1101 1 ) 021 ) 031111111111111 <br /> 1 1 01 l ) 02 ( 1 03 <br /> 1 1 Ol ( ) 02 ( ) 03 <br /> 1 ) 01 t 102_1 1 0� <br /> OOl 1102 l ) 031111111111111 <br /> -1 11-01 ( , G2 I ) 03 L <br /> i 1 01 ( ) 02 ( ) 03 <br /> 01 )-02 1 1 03 <br /> IS CO-ITAINCR LOCATED ON AN AGRICULTURAL FARM? t ) 01 YES 10 02 NO <br /> THIS FORM H N COMPL D ER IE PENALTY OF PERJURY AIA, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> P:Is•• i ADNA HYDRO-SEARCH. INC• PHONE W/AREA CODE <br /> dyy 333 Flint Street 702/3?.2-4173 <br /> Reno, NV 89501 <br /> FOP. LOC AGENC USE ONLY <br /> 401111ISTPAT:NZ AjE,1CY CITY CODE COUNTY CODE <br /> CONTACT P:fSON ►NONE W/ARCA COOL <br /> CITE 01 LAST INSILCTION IN COMPLIANCE ILRMIT A►PROVAL DATE TRANSACTION DATE LOCAL PERMIT 10 R <br /> ---.- - --_ 1 1 R1 TIE 1 1 OE 110 <br /> HSCG4-070185 PAGE 2 <br />