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• • - • STATE ID NUMBER 00000002918012 <br /> CONTAINER CONSTRUCTION <br /> rF. ( <br /> )(Xl 07ol 8UN LINEDEO( 1 OS UNKNOWN LI ::d <br /> ( 1ER3 EPDXY LINING ( l 04 PHENOLIC LINING ( ] 05 GLASS LINING <br /> l(0) 06LTARHORNASPHALT ((11009VOINYL THERWRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( 1 05 NONE <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: <br /> ( ( 01104 PRESSURE 05 <br /> 1105 SUCTION CONCRETE-LINED 06UNKNOWNTR`NCH07(NONE3 GRAVITY <br /> RIATE <br /> CHECK <br /> RIATE <br /> B. UNDERGROUND PIPING: t l 01 DOUBLE-WALLED PIPE l l 02 CONCRETE-6UNKNOWNTR(N;HO E3 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE <br /> yLl�>;1�T � <br /> VLI LEAK DETECTION <br /> ( NL VAPOR <br /> SNIFF LLS SENSOR INSTRUMENT <br /> (X) 01 VISUAL <br /> ) 02 STOCK 10 OTHER: <br /> 0GROUNDWATER MONITORING 107PRESSU <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO iV-F YOU APE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PPEVIOV'S LY DELETE CAS# (IF KNOWN) <br /> CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> STORED STOPED <br /> (X1 O1 ( ) 02 ( 1 03 <br /> ALIPHATIC (325 THINNER) <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( ) O1 ( ) 02 f 1 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( ) O1 [ ) 02 ( ) 03 <br /> f 1 01 ( ) 02 ( ) 03 <br /> ( ] O1 ( ) 02 ( ) 03 <br /> ( I <br /> 01 ( 1 02 ( ) 03 <br /> r 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 P NA LTY OF PERJURY AND, TO SHE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PHONE <br /> ./APPA C`D.E- <br /> PERSO F LING f5' .4T RE <br /> FOR LOCAL AGENCY USE ONLY <br /> Q/S' CITY CODE COUNTY CODE <br /> AOMINISTP.ATIN3 AGENCY //v <br /> --5709W tf / / PHONE W/AREA=00E p <br /> CONTACT PERSON j / „/ Q��J/// �/]/y/%9 CJ - <br /> �f,V �J tel-% TRANSACTION DATE LOCAL PERMIT iD '3 <br /> GATE OF LAST' =NSPECTION IN COMPLIANCE <br /> PERMIT APPROVAL DATE <br /> Ol YES ( 1 02 NO <br /> PAGE 2 <br /> HSC04-070185 (10/18/85) <br />