Laserfiche WebLink
STATE ID NUMBER 00000066587001 <br /> CONTAINER CONSTRUCTION <br /> E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( } 03 EPDXY LINING i 1 04 PHENOLIC LINING i D 05 GLASS LINING <br /> ( ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER. <br /> F. ( ) 01 POLYETHLENE WRAP I ) 02 VINYL WRAPPING ( } 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( 1 05 NONE <br /> ( ) 06 TAR OR ASPHALT ( D 09 OTHER= <br /> VI PIPING <br /> A. ABOVEGROUND PIPING= t ) 01 DOUBLE-WALLED PIPE 1 ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APFROPRIAT€ BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION (X) 06 UNKNO14N ( ) 07 NONE <br /> B. UNDERGROUND PIPING= ( ) 01 DOUBLE-WALLED IPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE %IF' 05 SUCTION ( ) 06 UNKNOWN i ) 07 NONE <br /> VII LEAK DETECTION <br /> (X) 01 VISUAL (X) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS C ) 07 PRESSURE TEST ( l 09 NONE ( } 10 OTHER= <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 /> CURRENTLY PREVIOUSLY DELETE CASU (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> ( ) al ( l 02 ( 1 03 <br /> ( l 01 ( } 02 ( 1 03 <br /> ( ) <br /> 01 ( 1 02 ( l 03 <br /> f 1 01 ( ) 02 ( ) 03 <br /> 1 ) 01 ( ) 02 ( 1 03 <br /> 1 ) O1 ( ) 02 ( ) 03 <br /> ( l <br /> 01 ( ) 02 ( 1 03 <br /> ( 1 01 ( ) 02 ( 1 03 <br /> t 1 O1 ( } 02 ( 1 03 <br /> ( ) 01 F 1 02 t l 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 /> P RSON FILING (SIGNAT RE ) PHONE W/AREA CODE <br /> ..r <br /> 1 (A"',av/ <br /> FOR LOCAL AGENCY USE ONLY l <br /> AOMINISTRATING AGENCY ! CITY CODE COUNTY CODE <br /> CONTACT O o �4 /r _ 7e PHONE W/AREA CODE <br /> DATE OF LAS INS�iC ON IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID St <br /> 01 YES ( I 02 NO <br /> HSC04-070185 (08/29/86) PAGE 2 <br />