Laserfiche WebLink
STATE ID NUMBER 00000024361001 <br />nucronPT T nM <br />GuniAlncR vun:a, n..v•... • <br />01 RUBBER LINED ( ) 02 ALKYD LINING f 1 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( ) 05 GLASS LINING <br />(X) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: <br />( ) 01 POLYETHLENE WRAP ( 1 02 VINYL WRAPPING f 7 03 CATHODIC PROTECTION ( l 04 UNKNOWN (X) 05 NONE <br />( ) 06 TAR OR ASPHALT ( ) 09 OTHER: <br />'I Y1Y 1)NLI <br />1. ABOVEGROUND PIPING: ( ) 01 DOUBLE -WALLED PIPE ( ) 02 CONCRETE -LINED TRENCH ( ) 03 GRAVITY <br />(CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br />S. UNDERGROUND PIPING: ( l 01 DOUBLE -WALLED PIPE ( ) 02 CONCRETE -LINED TRENCH ( ) 03 GRAVITY <br />(CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br />nCTCf TTnM <br />I11 Llnl v r �v • a•+•• <br />( ) 01 VISUAL ( 1 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS 1 ) 05 SENSOR INSTRUMENT <br />( ) 06 GROUND WATER MONITORING WELLS (X) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: <br />VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br />-- . -,. — — .F1111.Fn 11 GDMPLFTE THIS SECTION <br />CURRENTLY <br />STORED <br />PREVIOUSLY <br />STORED <br />DELETE CAS# (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) <br />( ) 01 <br />f 7 02 <br />( <br />) 03 <br />( 1 01 <br />( l 02 <br />( <br />) 03 <br />( ) 01 <br />( l 02 <br />( <br />) 03 <br />( 1 01 <br />t ) 02 <br />( <br />) 03 <br />( I 01 <br />l ) 02 <br />( <br />) 03 <br />f 7 01 <br />t 7 02 <br />( <br />) 03 <br />( ) 01 <br />[ l 02 <br />( <br />) 03 - <br />( ) 01 <br />( l 02 <br />( <br />) 03 <br />( ) 01 <br />( ) 02 <br />( <br />) 03 <br />( l 01 <br />f l 02 <br />( <br />) 03 <br />• CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br />ES CONTAINER LOCATED ON AN AGRICULTURAL FARM? (X) 01 YES ( ) 02 NO <br />TUTS FROM HAS AFFN COMPIFTFn UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br />-EPSON FILING (SIGNATURE) PHONE W/AREA CODE <br />PnR incAl. AGENCY USE ONLY <br />ADMINISTRATING AGENCY CITY CODE. COUNTY CODE <br />CONTACT PERSON PHONE W/AREA CODE <br />DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # <br />( 1 01 YES ( ) 02 NO <br />HSC04-070185 (10/18/83) <br />u- <br />PAGE 2 <br />