COMPLIANCE INFO_1987-1998 - Laserfiche WebLink

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STATE ID NUMBER 00000017798001 CONTAINER CONSTRUCTION E. ( ) 01 RUBBER LINED t ) 02 ALKYD LINING t ) 03 EPDXY LINING ( l 04 PHENOLIC LINING ( ) 05 GLASS LINING ( ) 07 UNLINED (X) 08 UNKNOWN ( ) 09 OTHER F. ( ) 01 POLYETHLENE WRAP t ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( J 05 NONE ( ) 06 TAR OR ASPHALT t ) 09 OTHER: VI PIPING A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE t ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE t ) 05 SUCTION ( ) 06 UNKNOWN t 107 NONE B. UNDERGROUND PIPING E ) 01 DOUBLE-WALLED PIPE t 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY (CHECK.APPROPRIATE BOX(ES) ( ) 04 PRESSURE %,) 05 SUCTION 06 UNKNOWN t ) 07 NONE VII LEAK DETECTION t ) 01 VISUAL Q6 02 STOCK INVENTORY ( l 04 VAPOR SNIFF WELLS ('1 05 SENSOR INSTRUMENT , ) 06 GROUND WATER MONITORING WELLS '( ) 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 PREVIOUSLY DELETE CAS## (IF KNOWN) CHEMICAL (DO NOT USE COMMERCIAL NAME) STORED STORED ( 3 01 ( 1 02 ( ) 03 01 ( ) 02 ( ) 03 ( J 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 t ) 01 ( ) 02 ( ) 03 t l 01 t l 02 ( ) 03 t 1 01 ( ) 02 ( ) 03 t ) 01 ( ) 02 ( ) 03 ( ) 01 ( ) 02 ( ) 03 t ) 01 ' ( ) 02 ( ) 03 CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? t ) 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. PER ON FI N URE) PONE W/AREA CODE FOR LOCAL AGENCY USE ONLY ADMINI TRATING AGENCY p CITY C E COUNTY CODE CONTACT PERSO PHONE W/AREA CODE Q DATE OF LAST INSPECTION IN COMPLIANCE PERMIT AP'RROVAL DATE TRANSACTION DATE LOCAL PERMIT IO #k ( ) 01 YES C 3 02 NO HSC04-070185 (-30/18/85) PAGE 2 I