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STATE ID NUMBER 00000021906002 <br /> CONTAINER CONSTRUCTION <br /> E. i } 01 RUBBER LINED ( ) 02 ALKYD LINING ( 1 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( f 05 GLASS LINING <br /> ( ) 07 UNLINED ( 1 08 UNKNOWN ( ) 09 OTHER: <br /> F. t ) O, POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION ( 1 04 UNKNOWN ( ) 05 NONE <br /> (x) 06 TAR OR ASPHALT f ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: i 1 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) t ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) i ] 04 PRESSURE 05 SUCTION t ) 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> ( 1 01 VISUAL ( ) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS ( 1 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YCU CHECkED YES TO IV—F YOU APE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CASs: (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> STORED STOPED <br /> ( l 01 ( ) 02 ( l 03 <br /> ( ) 01 ( 1 02 ( l 03 <br /> ( ) 01 ( ) 02 C ) 03 <br /> ( 1 <br /> 01 ( ) 02 ( 1 03 <br /> ( 7 01 C ) 02 ( 1 03 <br /> C } 01 f ) 02 ( } 03 <br /> C l 01 ( ) 02 ( l 03 <br /> 1 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( 1 01 C ) 02 [ l 03 <br /> CHECK STATE BOARD CHEMICAL COME LISTING FOR POSSIBLE SYNONYMS <br /> LIS CONTAINER LOCATED ON AN AGRICULTURAL FARM? C 1 01 YES (ld' 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGEr IS TRUE AND CORRECT. <br /> PEPS FI N.AT PHCNE W/AREA CODE j <br /> t (/ <br /> FOR LOCAL AGENCY USE ONLY i <br /> ADMINISTRATING AGENCY lS 7 CITY CODE COUNTY CODE <br /> f r) L06-AL t+C c-\ (r-r kA <br /> CONTACT PERSON PHONE W/AREA CODE <br /> ---[ <br /> DATE�OF LAST ySPjECTION IA! COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID <br /> L_lfQJ f1f•/� ( ) 01 YES ( ) 02 NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br />