COMPLIANCE INFO_1986-1989 - Laserfiche WebLink

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>TATE ID NUMBER CONTAINER CONSTRUCTION :. ( 101 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( D 04 PHENOLIC LINING ( ) 05 GLASS LINING ( ) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: _ a ( l 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( D 03 CATHODIC PROTECTION ( ) 04 U)(KNOWN ( D 05 NONE ( ) 06 TAR OR ASPHALT ( ) 09 OTHER: (I PIPING 1. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE t ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04' PRESSURE ( D 05 SUCTION C ) 06 UNKNOWN ( } 07 NONE ). UNDERGROUND PIPING: ( D 01 DOUBLE-WALLED PIPE ( l 02 CONCRETE-LINED TRENCH ( D 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( D 07 NONE `II LEAK DETECTION t ) 01 VISUAL ( ) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE ( ) 10 OTHER: 'III CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION URRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (00 NOT USE COMMERCIAL NAME) STORED STORED ( ) 01 ( ) 02 ( ) 03 1 ( ) 01 ( ) 02 ( l 03 lel l t 1L1 11 1I II !I I ( } 01 ( ) 02 ( ) 03 I I i I I H L—L1�__i — ( D 01 ( ) 02 f l 03 "— ( ) 01 _( ) 02 t ) 0_3H_ i D 01 ( } 02 O 03 ` I I I I I I I I I I LL O 01 O 02 ( D 03 t ' 01 ` ' 02 ` ' 0311 — : ) 01_-- `--'-02 t D o3.1_LL1_L11.1_1_l_1_L"l_ _) 01 t_l 02_( ) 03 ( I I CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES ( D 02 NO S FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PSON FILING (SIGNATUFE) PHONE W/AREA CODE )R LOCAL AGENCY USE ONLY MINISTPATING AGENCY CITY CODE COUNTY CODE NTACT Pc-;SDN PHONE W/AREA CODE TE OF LAST INSPECTION tlN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # 01 YES ( ) 02 NO 04-079185 c �' PAGE 2 3 S ted 3 d�� .E.�)`F�`•_.•,• r- ,_; z �_" , -L 03onooN,r4m