COMPLIANCE INFO_1986-1995 - Laserfiche WebLink

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STATE ID NUMBER 00000013318003 CONTAINER CONSTRUCTION E. ( l 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( 104 PHENOLIC LINING t J 05 GLASS LINING (X) 07 UNLINED ( ) 08 UNKNOWN t ) 09 OTHER: F. ( ) 01 POLYETHLENE WRAP ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION t ) 04 UNKNOWN (X) 05 NONE ( ) 06 TAR OR ASPHALT ( ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) (X) 04 PRESSURE t D 05 SUCTION ( ) 06 UNKNOWN ( I 07 NONE VII LEAK DETECTION t ) 01 VISUAL (X) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE (X) 10 OTHER= LINE LEAK DETECTORS VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STORED STORED ( ) 01 ( ) 02 ( ) 03 01 ( ) 02 ( ) 03 ( 101 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 ( I al ( ) 02 ( ) 03 t ) 01 ( ) 02 ( ) 03 ( ) 02 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 ( l 01 ( ) 02 ( ) 03 CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO zn THIS FORM H BEN COMPLETED NDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PERSON ING (SIGN R PHONE W/AREA CODE , FOR LOCAL AGENCY USE ONLY ADMINISTRATING AGENCY IS f CITY CODE COUNTY CODE 20tlU LAI G4 e, l CONTACT PERSON PHONE W/AREA CODE DATE OF LAST I S ECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT 'IO # -13-- -1 / ( ) 01 YES ( ) 02 NO DATE OF LAST ZWS HSC04-070185 (10/18/85) PAGE 2