Laserfiche WebLink
STATE IO MURDER <br /> CONTAINER CONSTRUCTION <br /> C. 1 1 01 RUBBER LINED �( 1 02 ALKYD LINING 1 1 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( 1 05 GLASS LINING <br /> A <br /> I 1 07 UNLINED `R' 04 UNKNOWN ( 1 09 OTHER: <br /> F. 1 ) 01 POLYETHLENE WRAP t 1 02 VINYL WRAPPING 1 1 03 CATHODIC PROTECTION t1 04 UIMNONN l 1 05 NONE <br /> 1 1 06 TAR OR ASPHALT ( ) 09 OTHER: s•� <br /> VI PIPING <br /> A. ABOVEGP.OUIM PIPING: f 1 01 DOUBLE-WALLED PIPE 1 1 02 CONCRETE-LINED TRENCH 1 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOXIEST 1 1 04 PRESSURE ( 1 05 SUCTION 1 1 06 UNKNOWN 1 1 07 HONE <br /> S. UNDERGROUND PIPING 1 1 01 DOUBLE-MALLEO PIPE ( 1 02 CONCRETE-LINED TRENCH I 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) 1 1 04 PRESSURE l 1 05 SUCTION ( 1 06 (UNKNOWN 1 1 07 NONE <br /> VII LEAK DETECTION <br /> 1 1 O1 VISUAL & 02 STOCK INVENTORY 1 104 VAPOR SNIFF WELLS 1 ) OS SENSOR INSTRUMENT <br /> l 1 06 GP.OUI WATER MONITORING WELLS l 1 07 PRESSURE TEST ( 1 09 NONE ( 1 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV•F YOU ARE NOT RE4Ui RED TO COMPLETE THIS LECTION <br /> CURRENTLY PREVIOUSLY DELETE CASK (IF KNOWNI CHEMICAL 100 NOT USE COMMERCIAL NAMEI <br /> STORED STORED <br /> 01 f l 02 ( 1 03 ' <br /> ( 1 0l 1 1 02 11 <br /> OS ALL..-L,I 1 1 1 1 111 IL_ILILII...ILI <br /> 11 Ol_ I l 02 l 1 0; 1 1 1 1 1 1I 1 <br /> 1 101 1 ) 02 1 1O'W i I l I I i I I i l <br /> 1101 ( 102 110331111111111111 <br /> 1 1 01 ( 1 02 ( 1 OLLI <br /> L 1 1 1 1 1 1 I 1 I I 1 <br /> 1 1 tll_ 1 1 02 O 031 1 1 1 1 1 1 1 1 1 1 1 1 <br /> 1 ) 01-- ---1 1 02 I l 0 <br /> 3I I1J1 <br /> _f ) Ol_ 1—)_02 1 1 03 <br /> Ol---`- '-02 .1 <br /> '-- `-- 1—D3 <br /> I <br /> �lHLJI _.------ --- -- ---------- <br /> IS C.C:ITAINCR LOCATED ON AN AGRICULTURAL FARM? t 1 01 YES 1 1 02 NO <br /> THIS0 M S BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE. I5 TRUE AND CORRECT. <br /> P.cg f t --___ — <br /> SIGNATUGFI GHON[ W/AREA CODE <br /> ZP � <br /> FOP. L L AGENCY USE ONLY <br /> IAD-2 N•••va T: J:C 1' CITY CODE COUNTY CODE <br /> SAFr ToARLAarl LCL✓ Iii-/{LSH P1s?.__ <br /> 1ED•.:ACI C :Lq� PHONE WIA.E COOE,57,g �3/2 <br /> 17-7, <br /> J `7 r� t �(., <br /> OAT[ O•—t�1 INSPECTION IIN CO`;TIE SC[, 1 02 YO IPCRMIT APPROVAL OATC -- ITP ANSACTION DATC - <br /> LOCAL -PERMIT ID P <br /> ISC04-0.111P.5'!YM/ I. I PAGE 2 <br />