COMPLIANCE INFO_1985-1998 - Laserfiche WebLink

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STATE ID NUMBER 00000057864001 CONTAINER CONSTRUCTION ( l 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ) 05 GLASS LINING ( l 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER: ( ) 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION ( ) 04 UNKNOWN ( l 05 NONE (X) 06 TAR OR ASPHALT ( l 09 OTHER: VI PIPING 1. ABOVEGROUND PIPING: ( 1 01 DOUBLE -WALLED PIPE ( ) 02 CONCRETE -LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE 1. UNDERGROUND PIPING: ( ) 01 DOUBLE -WALLED PIPE ( ) 02 CONCRETE -LINED TRENCH (;1 03 GRAVITY (CHECK APPROPRIATE BOX(ES) t ) 04 PRESSURE (>4, 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE VII LEAK DETECTION ( ) 01 VISUAL ( ) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( ) 05 SENSOR INSTRUMENT t ) 06 GROUND WATER MONITORING WELLS t ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: 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 STORED PREVIOUSLY STOPED DELETE CASs! (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) ( ) 01 ( ) 02 ( ) 03 ( ) 01 ( l 02 ( ) 03 ( ) 01 ( 1 02 ( ) 03 ( 1 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 l 01 ( l 02 ( ) 03 ( ) 01 ( ] 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 t l 01 ( I 02 ( ) 03 t ) 01 ( l 02 ( ) 03 * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS ES CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO (IS FORM HAS BEEN COMPL TED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. slow UR 1976 /AR CODE FOR LOCAL AGENCY USE ONLY ADMINI.STRATING—AGENCY CITY CODE COUNTY CODE CONTACT PERSON PHO W/AREA CODE DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID tt ( ) 01 YES ( ) 02 NO NSC04-070185 110/18/85) PAGE 2