BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

�.- ✓ STATE ID NUMBER 00000061790004 CONTAINER CONSTRUCTION E. ( 7 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( 1 05 GLASS LINING (X) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: F. ( ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING f ] 03 CATHODIC PROTECTION f 1 04 UNKNOWN (X) 05 NONE ( ) 06 TAR OR ASPHALT l ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING ( ) 01 DOUBLE-WALLED PIPE f 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY [CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE S. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) lJQ 04 PRESSURE ( ) 05 SUCTION ( ] 06 UNKNOWN ( 1 07 NONE VII LEAK DETECTION ( ) O1 VISUAL fX) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS ( ] 05 SENSOR INSTRUMENT ( 1 Ob GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST 1 ) 09 NONE ( ) 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STOPED STOPED ( ) 01 ( ) 02 ( ) 03 1 ) Ol ( ) 02 ( 1 03 ( l 01 f ) 02 ( 1 03 ( l 01 ( 1 02 ( ) 03 ( l al ( 102 ( ) 03 ( ) 01 ( ) 02 ( ) 03 f ) 01 ( ) 02 ( ) 03 f l O1 ( ) 02 ( ) 03 f l 01 f l 02 ( 1 03 ( 1 01 f 102 ( ) 03 ■ CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO THIS F HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PERS N ILING (SIGH/( EI Y PHONE W/AREA CODE /VY FOR LOCAL AGENCY USE ONLY ADMINISTRATING AGENCY CITY CODE COUNTY CODE CONTACT PERSON PHONE W/AREA CODE DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT IO # ( ) 03 YES f 1 02 NO HSC04-070185 (10/18/85) PAGE 2