BILLING_1984 - 1999 - Laserfiche WebLink

Home Browse Search

STATE ID NUMBER CONTAINER CONSTRUCTION E. C ')"01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( 1 04 PHENOLIC LINING ( 1 05 GLASS LINING ( ) 07 UNLINED ( 1 08 UNKNOWN ( ) 09 OTHER: 01 POLYETHLENE WRAP ( 1 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION ( 1 04 UNKNOWN ( ) 05 NONE - ( 1 06 TAR OR ASPHALT ( ) 09 OTHER: J (VI PIPING IA. ABOVEGP.OUND PIPING ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH 1 1 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( 1 05 SUCTION ( 1 06 UNKNOWN ( 1 07 NONE S. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( 1 02 CONCRETE-LINED TRENCH l ) 03 GRAVITY I� (CHECK APPROPRIATE BOX(ES) ) 04 YESSURE ( 1 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE 2 �„ II LEAK DETECTION _ ( ) 01 VISUAL ( 1 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT W,ATEP "nr,TTORINr, DELLS r ) 07 PRESSURE TEST t 1 09 NONE ( ) 10 OTHER: VIII C14EMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION !CUPRENTLY PPEVIOUSLY DELETE CASE! (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME ) STOPED STORED - t ( ) 01 ( ) 02 f ) 031 1 1 1 1 1 1 111111 O 01 ( 1 02 ( -) 03 ( ) 01 ( ) 02 ( ) 031 11 1 1 I 1 I I I I I I -- ( ) 01 ( ) 02 ( ) 031 11 11 1 1 1 11111 — O 01 ( 02 O 03 1 1 1 1 1 Ll 1 I I I I I -- O 01 ( 02 ( 1 03 O 01 ( 02 O 03 - 1101 _ ( 102 O03Ll1IiIIIIIIII -- 001_ 002 0031111111 l l l l l l O 01 ( 1 02 1 1 03 1 1 1 1 1 I I I I j I I I - tlS ;.0ATAINER LOCALED ON AN AGRICULTUPAL FiAlcJi. l i 01 YES 0% r.. T��H--IS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. )P!P�: FILING ( IGNATUPE ) PHONE W/AREA CODE - FOP. LOCAL AGENCY USE ONLY IADY,Ir STPA7 nG AGENCY --- CZ� CQDE — �COVr:TY CODE C IC01471rT D-G�('N PHONE W/AREA CODE DATE O' LAST ZNSrECTION IN COMPLIANCE PEPMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT IO P O1 )ES t 1 02 NO .i5C04-079185 PAGE 2