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STATE ID NUMBER. 00000000723002 <br /> CONTAINER CONSTRUCTION <br /> E. C l 01 RUBBER, LINED t ) 02 ALKYD LINING ( 1 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> (X) 07 UNLINED ( l 08 UNKNOWN ( l 09 OTHER: <br /> F. i ) 01 POLYETHLENE WRAP ( 1 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION ( 1 04 UNKNOWN <br /> 1 06 ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH C 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) (X) 04 PRESSURE ( ) 05 SUCTION t l 06 UNKNOWN ( 1 07 NONE <br /> VII LEAK DETECTION <br /> ( ) 01 VISUAL (,t 02 SJOCK INVENTORY (X) 04 VAPOR SNIFF WELLS ( l 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND-WATER MONITORITW WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU A.P.: NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY" DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STC-ED STCF.ED <br /> 1 01 i 1 02 ( ) 03 <br /> f l 01 ( ) 02 ( 1 03 <br /> ( l 01 ( 1 02 ( 1 03 <br /> ( ) 01 C l 02 ( ) 03 <br /> 1 01 ( 1 02 ( ) 03 <br /> ( 1 O1 C 1 02 ( 1 03 <br /> ( 1 01 C ) 02 ( 1 03 <br /> i 1 01 ( 1 02 ( 1 03 <br /> t 1 Ol ( ) 02 C ) 03 <br /> ( l 01 ( 1 02 ( 1 03 <br /> * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? t 1 01 YES (X) 02 NO <br /> THIS O M HAI BEEN 0 LETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGEr IS TRUE AND CCP.RECT. <br /> FEPSO Il�4,J4 TUE ) _- PHONE W/.AREA CODE <br /> z <br /> 7.) G <br /> FOR CAL AGENCY USE ONLY <br /> ADMINISTRATING AGENCY CITY CODE CCUNTY CODE <br /> v�1 �(j( (n,i+t L_�c 4cp,- 1-4e a,(f L. V) r s 7 <br /> CONTACT PERSON PHONE W/APEA CODE <br /> 7o a 2cJ — �3S=�7�_O <br /> GATE OF LAST TNS ECT ON IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT IO # <br /> -f- ( f 01 YES f ) 02 NO <br /> HSC04-070180005/// (10/18/85) PACE 2 <br />