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STATE ID NUMBER 00000034927003 CONTAINER CONSTRUCTION E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( l 05 GLASS LINING ( ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: F. ( ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( ) 05 NONE ( ) 06 TAR OR ASPHALT ( l 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE—WALLED PIPE ( ) 02 CONCRETE—LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN J�"7 NONE B. UNDERGROUND PIPING ( ) 01 DOUBLE—WALLED P;FE ( ) 02 CONCRETE—LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) 04 PRESSURE .JKT 05 SUCTION ( 1 06 UNKNOWN ( 1 07 NONE VII LEAK DETECTION 01 VISUAL (tb<l 02 STOCK INVENTCRY ( l 04 VAPOR SNIFF WELLS (X) 05 SENSOR INSTRUMENT ( ) 06 GP.OUND'TiTER MONITORING WELLS ,SSS) 07 PRESSURE TEST ( ) 09 NONE (>O 10 OTHER2--za-4- VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECL:EC YES TO IV-F YOU APE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY FF.EVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STCPED STORED ( ) 01 ( l 02 ( 1 03 t ) 01 ( l 02 ( l 03 ( l 01 ( l 02 t ) 03 ( 1 01 ( ) 02 ( l 03 ( ) 01 ( l 02 ( 1 03 ( ) 01 t ) 02 t l 03 ( l 01 ( ) 02 ( ) 03 ( ) 01 ( l 02 ( ) 03 ( ) 01 t ) 02 �( ) 03 ( l 01 ( ) 02 1 ) 03 * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO THIS FORM HAS BEEN COMPLETED UNDER, THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PEFS ILING (SiGNATUR-e) PHONE W/AP.EA CODE FO LOCAL AGENCY USE ONLY ADMINISTRATING AGENCY SAN JOAQUIN LOCAL HEALTH DISTRICT CITY CODE COUNTY CODE CONT T PERSON PHONE W/AREA CODE Lo u-1 DATE OF LAST INSPECTION IN COMPLIANCE FERMI; APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # 01 YES ( ? 02 NO HSC04-070185 (10/18/85) 5 PAGE 2