BILLING - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER 00000053663002 CONTAINER CONSTRUCTION E. ( 1 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING f ) 05 GLASS LINING (X) 07 UNLINED ( ) 08 UNKNOWN ( 1 09 OTHER' F. ( l 01 POLYETHLENE WRAP 'l ) 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION ( ) 04 UNKNOWN (X) 05 NONE ( ) 06 TAR OR ASPHALT f 1 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE f ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION f l 06 UNKNOWN ( 107 NONE VII LEAK DETECTION ( ) 01 VISUAL ( ) 02 STOCK INVENTORY ( ] 04 VAPOR SNIFF WELLS ( l 05 SENSOR INSTRUMENT ( ] 06 GROUND WATER MONITORING WELLS f ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STORED STOPED f 101 ( 7 02 ( 1 03 ( ) 01 ( 1 02 ( ) 03 ( ) 01 ( l 02 f 1 03 ( ) 01 ( ) 02 f ) 03 ( ) 01 f 1 02 f ) 03 ( ) 01 ( l 02 ( ) 03 f 1 01 ( 7 02 ( 1 03 ( l 01 ( ) 02 ( 1 03 ( 1 Ol ( ) 02 ( ) 03 ( ) 01 ( ) 02 f 1 03 ■ CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? f ) 01 YES (X) 02 NO THIS FORM HAS BEEN COMPLETED UNDER THE TY PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PERSON FILING (SIGNATURE) PHONE AREA a C E FOR LOCAL AGENCY USE ONLY ADMIN;STRAYING AGENCY � tN. / CITY CODE COUNTY CODE CO NT ACT/"Q E�SOON PHO�\Wa ARBA COp� _ r�a` DATE OF LAST INSPECTION IN COMPLIANCEIT APPROVAL DATE TRANSACTION DATE J IJL LOCAL PERMIT I0 # ( ) Ol YES RSC04-070185 (10/18/85) PAGE 2