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CONTAINER CONSTRUCTION STATE ID NUMBER 00000002918001 <br /> F1 01 RUBBER LINED [ l 02 ALKYD LINING ( 1 03 EPDXY LINING ( 7 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> (X) 07 UNLINED ( 1 08 UNKNOWN ( 1 09 OTHER: <br /> 1 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION ( ) 04 UNKNOWN [ ) 05 NONE <br /> (X) 06 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE f 1 05 SUCTION (. l 06 UNKNOWN f ) 07 NONE <br /> S. UNDERGROUND PIPING: ( 1 O1 DOUBLE-WALLED <br /> ( ) 02 CONCRETE-LINED TRENCH ( 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(E57 �i,Y,1u�y,wrytl _4MW (X) 05 SUCTION ( 1 06 UNKNOWN ( 1 07 NONE <br /> VII LEAK DETECTION <br /> s(X) 01 VISUAL ��yy,L,L.. 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> 06 OROUNO-WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE (X) 10 OTHER: SMELL <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> pl ( <br /> TLY PREVIOUSLY DELETE CAS# (IF KNOWN) <br /> D STORED CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> 1 f ) 02 ( 1 03 <br /> HEATER OIL OR HEATER FUEL <br /> 1 f ) 02 ( ) 031 f 1 02 ( 1 031 ( ) 02 ( ) 031 ( ) 02 ( 1 031 ( ) 02 ( ) 031 ( ) 02 ( ) 03( 1 02 ( ) 03( ) 02 ( ) 03( ) 02 f 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 FO HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PER D F LING f NAT,pe) ' <br /> PHONE W/AREA CODE <br /> FOR LOCAL AGENCY USE ONLY <br /> AOMINISTpA TING gDENCY O/� 4*4--4 CITY CODE <br /> ��/Tj/-V/l./T•/b' COUNTY CODE <br /> CONTACT PERSON <br /> N PHONE W/AREA CODE <br /> DATH OF LAST IN SP ECTION IN COMPLIANCE PERMIT APPROVgI DATE TRANSACTION DATE <br /> Z'��_ � ( ) 01 YES ( ) 02 NO LOCAL PERMIT ID # <br /> SC04-070185 (10/18/85) <br /> PAGE 2 <br />