Laserfiche WebLink
STATE ID NUMBER 00000043411003 <br /> CONTAINER CONSTRUCTION <br /> E. f 1 01 RUBBER LINED f 1 02 ALKYD LINING (X) 03 EPDXY LINING ( 1 04 PHENOLIC LINING t ) 05 GLASS LINING <br /> ( } 07 UNLINED ( } 08 UNKNOWN ( ) 09 OTHER: <br /> F. ( ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING t l 03 CATHODIC PROTECTION (X) 04 UNKNOWN t 1 05 NONE <br /> ( 1 06 TAR OR ASPHALT t 1 09 OTHER: �. <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: i } 01 DOUBLE-WALLED PIPE t ) 02 CONCRETE-LINED TRENCH ( 1 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN t ) 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLEPIPE ( ) 02 CONCRETE-LINED TRENCH i ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) 1 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION ___= <br /> i ) 01 VISUAL (X) 02 STOCK INVENTORY f } 04 VAPOR SNIFF WELLS f ) 05 SENSOR INSTRUMENT <br /> ( 1 06 GROUND WATER MONITORING WELLS ( 1 07 PRESSURE TEST t ) 09 NONE t } 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> :F YOU CHECKED YES TO IV-F YOU APE NOT REOUIP D 70 COMPLETE THIS SECTION <br /> CUPP,ENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME ) <br /> STORED STOFEO <br /> ( } 01 ( ) 02 ( 1 03 <br /> ( l <br /> 01 ( } 02 ( ) 03 <br /> ( J 01 ( 1 02 t ) 03 <br /> ( 1 <br /> 01 ( ) 02 ( 1 03 <br /> { ) 01 [ 1 02 ( 1 03 <br /> ( ) 01 ( ) 07 ( ) 03 <br /> ( ) 01 t ) 02 ( ) 03 <br /> i } 01 ( ) 02 t 1 03 <br /> ( 1 01 ( ) 02 t ) 03 <br /> ( f 01 f ) 02 ( 1 03 <br /> * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( 1 01 YES (X) 02 NO <br /> THIS FORM HAS B N COMPLETED UNDER T I PENALTY OF PERJURY AND, T9 THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> P 0. FIL N SIGN TURE1 K PHONE W/AREA CODE <br /> 4!\ � <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTP.AWENO�.r, 7DATE <br /> COUNTY CODE <br /> CONTACT REP,SON AREA CODE — v <br /> d9d1/2l �/+� L/itf <br /> DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APTRANSACTION DATE LOCAL PERMIT i6 # <br /> —4—— 01 YES c ) 02 NO <br /> PAGE <br /> HSC04-0701//35 (10/1r$'/851 2 <br />