Laserfiche WebLink
STATE ID NUMBER 00000021136002 <br /> CONTAINER CONSTRUCTION <br /> E. ( l 01 RUBBER LINED ( ) 02 ALKYD LINING ( 1 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> ( ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: <br /> F. ( } 01 POLYETHLENE WRAP E ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION ( ) 04 UNKNOWN (X) 05 NONE <br /> ( ) 06 TAR OR ASPHALT f ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( 1 01 DOUBLE-WALLED PIPE C ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOXCES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: C ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH t ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) (X) 04 PRESSURE E 105 SUCTION C i 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> ( 1 01 VISUAL (X) 02 STOCK INVENTORY ( ] 04 VAPOR SNIFF WELLS ( } 05 SENSOR INSTRUMENT <br /> t ) 06 GRCJND WATER MONITORING WELLS C ) 07 PRESSURE TEST ( ) 09 NONE (X) 10 OTHER: leo <br /> V <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV^F YOU APE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CUPP.ENTLY PREVICUSLY DELETE CASU (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME ) <br /> STORED STOPED <br /> ( i <br /> 01 ( ) 02 ( 1 03 <br /> ( ) 01 ( l 02 ( ) 03 <br /> f ; 01 t ) 02 ( ) 03 <br /> C ) <br /> 01 ( ) 02 ( ) 03 <br /> ( 1 <br /> 01 ( ) 02 ( } 03 <br /> ( ) 01 ( } 02 ( ) 03 <br /> C ) 01 4 ) 02 t 1 03 <br /> ( ) <br /> 01 ( ) 02 t ) 03 <br /> E ) 01 C ) 02 ( ) 03 <br /> ( ) 01 ( 1 02 i 1 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 H B COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PERSON -ILI ' ( N.ATUR - PHONE W/AREA CODE <br /> FOR LOCAL AGENCY USE NLY <br /> ADMINISTRA71NG "ENCY CITY CODE COUNTY CODE <br /> CONTACT PERSON PHONE W/AR A CODE <br /> DATE OF LAST INSPECTION JIN COMPLIANCE ]�PEP�M17APPi;OVAL DATE TRANSACTION DATE LOCAL PERMIT ID # <br /> ( ) 01 YES t ) 02 NO <br /> HSC04-070185 (10/18/85) PAGE 2 <br />