BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

I STATE ID NUMBER 00000034927001 CONTAINER CONSTRUCTION E. ( ) 01 RUBBER. LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING ( ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: F. ( 1 01 POLYETHLENE WRAP ( 1 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( l 05 NONE ( ) 06 TAR OR ASPHALT ( l 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( l 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION &W-06 UNKNOWN ( ) 07 NONE B. UNDERGROUND PIPING- ( ) 01 DOUBLE-WALLED PIPE ( l 02 CONCRETE-LINED TRENCH (X) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( 1 05 SUCTION ( l 06 UNKNOWN ( 1 07 NONE VII LEAK DETECTION IO1 VISUAL (,>� 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT ( l 06 GROUND WATER MONITORING WELLS L>, r 07 PRESSURE TEST ( l 09 NONE ( ) 10 OTHER: VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS :F YOU CHECKED YES TO IV-F YOU APE NOT REQUIRED TO COMPLETE THIS SECTION (CURRENTLY PREV:OUSLY DELETE C.4S# (IF KNOWN) CHEMICAL (CO NOT USE COMMERCIAL NAME) STCPEC STC=ED 1 ( l 01 ( l 02 t l 03 ( l 01 ( l 02 ( ) 03 ( 1 01 f ) 02 ( ) 03 ( ) 01 ( 1 02 ( l 03 ( 1 01 f l 02 ( ) 03 ( ) 01 ( 1 02 t ) 03 I I I ( l 01 ( l 02 ( ) 03 ( ) 01 ( ) 02 ( 1 03 i ( l 01 ( l 02 ( l 03 ( 1 01 ( ) 02 ( l 03 CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IIS 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. fPEP N :LING (SIGN.4TUP'E) PHONE W/AREA CODE F R LOCAL AGENCY USE ONLY aOMIN:STRATING AGENCY SAN JOAQUIN LOCAL HEALTH DISTRICT CITY CODE COUNTY CODE CONTACT PERSON PHONE W/APEA CODE ATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # 01 YES ( ) 02 NO L_ v HSC04-070185 (10/18/85) CGE 2