BILLING 1985-2000 - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER 00000038750002 CONTAINER CONSTRUCTION 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING t ) 07 UNLINED IX) 08 UNKNOWN ( ) 09 OTHER: F. ( ) 01 POLYETHLENE WRAP ( J 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( ) 05 NONE E ) 06 TAR CR ASPHALT t ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING t ) 01 DOUBLE-WALLED PIPE C J 02 CONCRETE-LINED TRENCH C ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN t ) 07 NONE B. UNDERGROUND PIPING: t ) 01 DOUBLE-WALLED IP ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ) 04 PRESSURE ( 5 SUCTION ( ) 06 UNKNOWN t ) 07 NONE VII LEAK DETECTION ( ) 01 VISUAL (X1 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( 1 05 SENSOR INSTRUMENT ( ) p6 GROUND WATER MONITORING WELLS E ) 07 PRESSURE TEST OTHER VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YCU CHECXED YES TO IV-F YOU APE NOT R£GUIRED TO COMPLETE THIS SECTION CURRENTLY PPEVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STO^ED STOPED ( ) 01 ( 1 02 ( ) 03 ( 1 01 t l 02 f ) 03 ( ) 01 ( i 02 ( ) 03 ( l q1 t 1 02 ( ) 03 ( J 01 f ) 02 ( ) 03 ( ) 01 ( ) 02 f ) 03 ( ) 01 ( ) 02 ( ) 03 t ) 01 ( 1 02 t 1 03 f ) 01 ( ) 02 ( ) 13 ( ) 01 ( ) 02 ( ) 03 * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PEPSON FILING (SIGNATURE) PHONE W/AREA CODE FOR LOCAL AGENCY USE ONLY ADMINISTP.ATING AGENCY CITY CODE COUNTY CODE CONTACT PERSON PHO E W/ RE CODE DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # ( I 01 YES ( ) 02 NO PAGE 2 HSC04-070185 (10/18/85)