Laserfiche WebLink
VOW STATE ID NUMBER 00000004373003 <br /> CONTAINER CONSTRUCTION <br /> E. ( 1 01 RUBBER LINED ( ) 02 ALKYD LINING ( 1 03 EPDXY LINING [ ) 04 PHENOLIC LINING f l 05 GLASS LINING <br /> i ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: <br /> F. f J 01 POLYETHLENE WRAP t ) 02 VINYL WRAPPING [ l 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( ) 05 NONE <br /> ( ) 06 TAR OR ASPHALT ( J 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: f 1 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH [ ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) t ) 04 PRESSURE ( ) 05 SUCTION (X) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING- ( 1 01 DOUBLE-WALLED PIPE t ) 02 CONCRETE-LINED TRENCH i ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOXES) 14-21 4 PRESSURE (F" 05 SUCTION ( 1 06 UNKNOWN t 1 07 NONE <br /> VII LEAK DETECTI <br /> (X) 01 VISUAL ( ) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS f ) 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS i 1 07 PRESSURE TEST ( ) 09 NONE ( 1 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 /> CURPENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME ) <br /> STORED STOPED <br /> ( l 01 f ) 02 f 1 03 <br /> i l 01 ( 1 02 ( 1 03 <br /> f l 01 [ ) 02 E ) 03 <br /> f 1 01 t ) 02 ( ) 03 <br /> f 1 <br /> 01 ( ) 02 ( ) 03 <br /> [ } <br /> 01 [ ) 02 l ) 03 <br /> ( 1 <br /> 01 [ 102 f ) 03 <br /> [ ) 01 ( l 02 1 ) 03 <br /> f J 01 ( l 02 [ 1 03 <br /> ( J 01 E ) 02 ( ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( 1 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND( TO THE BEST OF MY KNOWLEDGE) IS TRUE AND CORRECT. <br /> PERSO p;+ N PHON / EA COD <br /> 1 _ <br /> FOR LOCAL AGENCY rSEONLY <br /> ADMINISTRATING AGENCY CITY CODE COUNTY CODE <br /> CONT T PEPSO PH NE W/ RE A CODE <br /> DATE OF LAST =NSPECTION �!N COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT IO tt <br /> C ) 01 YES ( ) 02 NO <br /> HSC04-070165 (10/18/85) PAGE 2 <br /> r-oll Iwo, <br />