Laserfiche WebLink
a ♦ a <br /> 90 <br /> TATE ID NUMBER <br /> CONTAINER CONSTRUCTION <br /> E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING t ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING <br /> (X) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: <br /> F. ( ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( D 03 CATHODIC PROTECTION t ) 04 L44KNOWN ( ) 05 NONE <br /> ( 106 TAR OR ASPHALT ( X) 09 OTHER: Fibersteel Coated Exterior <br /> VI PIPING <br /> A. ABOVEGROU140 PIPING: (X ) 01 DOUBLE-WALLED PIPE t D 02 CONCRETE-LINED TRENCH t XX) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) t ) 04' PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. U)(DERGROU)4D PIPING: FX 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( y) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( D 04 PRESSURE ( D 05 SUCTION ( D 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> Q) 01 VISUAL ( ) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS (XX) 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 079 NONE ( D 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 CAS# (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> STORED STORED <br /> tX D of ( ) 02 ( ) 03 Waste .automotive lubrication of l <br /> ( ) 01 t ) 02 ( ) 03 <br /> ( ) 01 t ) 02 ( ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 <br /> ( ) Ol ( ) 02 ( ) 03 <br /> ( ) Ol ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> t ) 01 ( ) 02 ( ) 03 <br /> ( ) Ol ( ) 02 ( ) 03 <br /> t ) 01 ( ) 02 ( ) 03 <br /> IS CO!(TAINER LOCATED ON AN AGRICULTURAL FARM? t D 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 /> PERSON FILING (SIGNATURE) PHONE W/AREA CODE <br /> (714) 851-2259 <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTRATING AGENCYCITY CODE COUNTY CODE <br /> CONTACT PERSON PHONE W/AREA CODE <br /> DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT 29 # <br /> t ) 01 YES t ) 02 NO <br /> ASC04-070185 PAGE 2 <br />