BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER 00000033591001 CONTAINER CONSTRUCTION [El ) O1 RUBBER LINED ( ) 02 ALKYD LINING ( 1 03 EPDXY LINING ( l 04 PHENOLIC LINING ( ) 05 GLASS LINING fX) 07 UNLINED ( ) O8 UNKNOWN ( ) 09 OTHER: ( 1 01 POLYETHLENE WRAP ( l 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION ( 1 04 UNKNOWN ( ) 05 NONE (X) 06 TAR OR ASPHALT ( ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE SOX(ES) ( ) 04 PRESSURE f l 05 SUCTION ( ) 06 UNKNOWN (311'07 NONE B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( ) 06 UNKNOWN f 7 07 NONE VII LEAK DETECTION ( ) V VISUAL V4 02 STOCK INVENTORY f 3 04 VAPOR SNIFF WELLS ( 1 05 SENSOR INSTRUMENT ) 06 GROUND WATER MONITORING WELLS t4f 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES -0 IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CAS# (If KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STORED STOPED ( 7 O1 ( ) 02 ( ) 03 f 1 01 ( ) 02 ( ) 03 ( ) 01 f ) 02 ( ) 03 ( 1 01 ( 1 02 ( ) 03 ( ) O1 ( 7 02 ( ) 03 ( ) 01 ( 7 02 ( ) 03 ( 1 al ( ) 02 ( ) 03 ( 1 01 ( 1 02 ( ) 03 ( 1 01 ( ) 02 ( ) 03 ( 1 O1 ( ] 02 ( ) 03 • CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( 7 01 YES (X) 02 NO THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PEPSON FILING (SI U PHONE W/AREA CODE FOR LOCAL AGENCY USE ONLY ADMINISTRATING AGENCY CITY CODE COUNTY CODE CONTACT PERSON PHONE W/AREA CODE OATS OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT I0 # f 1 01 YES f 1 02 NO MSC04-070185 (10/18/85) PAGE 2 rr