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y STATE ID NUMBER 00000018453003 <br /> CONTAINER CONSTRUCTION i <br /> t 1 O1 RU$BER LINED ( ) 02 ALKYD LIKING ( ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING 1 1 05 GLASS LINING <br /> t ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: <br /> 1 ) 01 POLYETHLENE WRAP ! 1 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION (X1 04 UNKNOWN l ) 05 NONE <br /> { 1 06 TAR OR ASPHALT t ) 09 OTHER: <br /> I PIPING <br /> ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH '( 1 03 GRAVITY <br /> tCHECK APFROPRIATE BOXES) ( ) 04 PRESSURE ( ) 05 SUCTION t ) 06 UNKNOWN t ) 07 NONE <br /> UNDERGROUND PIPING, ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIAIE BOX(ES) ( 04 PRESSURE ( ) 05 SUCTION Wl 06 UNKNOWN ( 1 07 NONE <br /> II LEAK DETECTION <br /> ( ) <br /> 01 VISUAL (X) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS ( 1 05 SENSOR INSTRUMENT <br /> t 1 06 GROUND WAFER MONITORING WELLS ( l 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: y <br /> III CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHSCfEJ YES TO IV'F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> »FENTLY PR_ViCUSIY DELETE CASK (IF KNOWN) CHEMICAL 100 NOT USE COMMERCIAL NAME) <br /> S'OFED <br /> ( ) OI ( ) 02 ( 1 03 <br /> 'T <br /> t 1 01 ( ) 02 t ) 03 <br /> ( 1 01 ( 1 02 ( 1 03 <br /> z <br /> ( l 01 t ) 02 ( 1 03 <br /> ! ) <br /> 01 t ) 02 ( ) 03 <br /> [ 1 01 [ ) 02 ( l 03 <br /> ( ) 01 ( 1 02 ( 1 03 <br /> ! ) 01 t ) 02 ( ) 03 <br /> t ) 01 ( 1 02 ( 1 03 1 <br /> ( 1 01 ( 1 02 ( 1 03 <br /> rt CHECK, STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> _ a <br /> S CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> IS F S BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> !-SON FILI IGNA/�_� PHONE W/AREA CODE <br /> OR LOCAL AGENCY USE ONLY <br /> OXINISTr,ATIN3 AS=NCY CITY CODE COUNTY CODE <br /> l5 <br /> ^,NT T PERSON PNO E W/ REA COOL G <br /> Iti Q <br /> --E OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LCCAL PERMIT IO t <br /> ( f 01 YES 1 1 02 NO <br /> PAGE <br /> 'C04-070185 (10/18/851 <br />