Laserfiche WebLink
0 . <br /> CONTAINER CONSTRUCTION STATE ID NUMBER 00000010313002 <br /> E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( 7 05 GLASS LINING <br /> ( 1 07 UNLINED (X1 08 UNKNOWN ( 1 09 OTHER: <br /> F. ( 1 Ol POLYETHLENE WRAP ( 1 02 VINYL WRAPPING f ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( ) 05 NONE <br /> ( 1 06 TAR OR ASPHALT ( ) 09 OTHER <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( 1 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH <br /> (CHECK APPROPRIATE BOX ( ) 03 GRAVITY <br /> BOX(ES) ( ) 04 PRESSURE ( l 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: f ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( 1 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> (X) 01 VISUAL (X) 02 STOCK INVENTORY ( 7 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS [ ) 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YO'J CHECKED YES TO IV-F YOU ARE NOT REQUIPED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) - <br /> STORED STORED CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> f I <br /> 01 ( ) 02 ( 1 03 <br /> f J 01 ( ) 02 ( 1 03 <br /> ( 7 <br /> 01 f ) 02 ( ) 03 <br /> ( l O1 f ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( 1 <br /> 01 ( ) 02 ( ) 03 <br /> 1 01 ( ) 02 ( ) 03 <br /> ( ) <br /> 01 ( 1 02 ( 1 03 <br /> f ] <br /> 01 ( ) 02 ( 1 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 /> PEP.SON FILI TU <br /> PHONE W/AR C00 <br /> z® �.- JS=Q77a <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTRATING '9(j`�NCY/� ,I �� 57 CITY CODE <br /> J/¢N VV A(XV IN �� / �]Yl ! N COUNTY CODE <br /> CONTACT P.0�%S hl PHONE W/gREA CODE <br /> 6 FSA OGv� - �3 S 0 -7 7 <br /> DATE O6LAS � SPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE <br /> / ( ) <br /> 01 YES ( ) 02 NO LOCAL PERMIT ID # <br />'SC04-070185 (10/18/85) <br /> PAGE 2 <br /> r <br />