COMPLIANCE INFO_1986-1990 - Laserfiche WebLink

Home Browse Search

STATE 10 NUMBER 00000009658003 CONTAINER CONSTRUCTION E. ( ) 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING t ) 04 PHENOLIC LINING ( ) 05 GLASS LINING (X) 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: F. ( ) 01 POLYETHLENE WRAP ( D 02 VINYL WRAPPING t ) 03 CATHODIC PROTECTION t D 04 UNKNOWN (X)05 NONE ( ) 06 TAR OR ASPHALT ( ) 09 OTHER= VI PIPING A. ABOVEGROUND PIPING: t ) 01 DOUBLE—WALLED PIPE ( l 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE B. UNDERGROUND PIPING= d ) 01 DOUBLE—WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) (X) 04 PRESSURE E )- 05 SUCTION ( D 06 UNKNOWN t D 07 NONE VII LEAK DETECTION t ) 01 VISUAL (X) 02 STOCK INVENTORY ( ) 04 VAPOR SNIFF WELLS ( D 05 SENSOR INSTRUMENT ( ) 06 GROUND WATER MONI`tORING WELLS f } 07 PRESSURE TEST ( ) 09 NONE (X) 10 OTHER: LINE LEAK DETECTOR 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,) STOPED STORED t ) 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 f ) 01 ( ) 02 ( ) 03 f D 01 ( ) 02 ( ) 03 i ) 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( .D 03 t ) 01 ( ) 02 { ) 03 01 ( ) 02 ( 103 ( l 01 ( ) 02 t ) 03 ( D 01 ( ) 02 ( ) 03 CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? { D 01 YES (X) 02 NO THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY Of PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PlSON {+IL N3 (SIGNA RE) c PHONE W/AREA CODE W �? FOR LOCAL AGENCY USE ONLY ADMINISTRATING AGENCY CY CODE COUNTY CODE CONTAC PERSON ` �PIjHONE W/AREA CODE 2 C : DATE OF LAST INSPECTION IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID # ( ) 01 YES ( ) 02 NO HSC"04-070185 (10/18/85) PAGE 2