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CONTAINER CONSTRUCTION STATE ID NUMBER 00000031633001 <br /> E <br /> R LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING f ) 05 GLASS LININGLINED ( ) 08 UNKNOWN f ) 09 OTHER: <br /> THLENE WRAP ( 1 02 VINYL WRAPPING ( 7 03 CATHODIC PROTECTION ( ) 04 UNKNOWN 05 NONE <br /> R OR ASPHALT f 1 09 OTHER: /> <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: [ ) 01 DOUBLE-WALLED PIPE f ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN jy 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE fX) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE i <br /> VII LEAK DETECTION <br /> f ) 01 VISUAL (X) 02 STOCK INVENTORY f ) 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> f 106 GROUND WATER MONITORING WELLS fa(! 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 ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) <br /> STCRED STORED CHEMICAL (00 NOT USE COMMERCIAL NAM!) <br /> ( l <br /> 01 ( ) 02 ( ) 03 <br /> ( I Ol ( ) 02 ( ) 03 <br /> f ) <br /> 01 ( 7 02 ( ) 03 <br /> ( ) 01 ( ) 02 f 1 03 <br /> f ) 01 f ) 02 ( 1 03 <br /> f 1 <br /> 01 ( 1 02 f ) 03 <br /> ( 1 <br /> 01 ( ) 02 ( ) 03 <br /> ( ) <br /> 01 ( 1 02 ( ) 03 <br /> f ) 01 ( 7 02 ( ) 03 <br /> ( ) <br /> 01 ( ) 02 ( ) 03 <br /> CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 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 /> PERSON Y <br /> LINO (SIGNATURE PHONE W/AR A COD <br /> 2 82�Z <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTRATIN�y,4.OENCY CITY CODE COUNT CODE <br /> Ja Lrce � <br /> CONTACT PERSONPHONE W/AREA CODE <br /> Ail Cle a 1 err g_ 9y,Y- <br /> ATE OF LAST INSPECTION IN CH L314 :ff PERMIT APPROVAL DATE TRANSACTION DATE LM OCPERMIT :D # <br /> f ) 02 NO <br /> q4-070185 (10/18/85)• PAGE 2 <br />