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Container Construction <br /> E. ®o+ Rubber Lined O o2 Alkyd Lining Ow Epoxy Lining O o. Phenolic Lining O o5 Glass Lining O oa Clay Lining <br /> 7 o+ Unlined O oe Unknown Z oe Other <br /> F. O of Polyethlene Wrap ❑02 Vinci Wrapping O oa Cathodic Protection <br /> O OA Unknown O oa None ❑Oa tar or asphalt O oa Other- Fiberglass. Reinforced <br /> Plastic <br /> VI Piping <br /> A. Aboveground Piping: O of Double-walled pipe ❑ oz Concrete-lined trench O oa Gravity ❑ OA Pressure ❑oa Suction <br /> [(Check) appropriate box(es)] ❑ oa Unknown ❑ o7 None <br /> B. Underground Piping: Mi Double-walled pipe O oz Concrete-lined trench O oa Gravity lb OA Pressure O oa Suction <br /> [(Check) appropriate box(es)] ❑oa Unknown O o7 None <br /> VII Leak Detection <br /> O or Visual O o2 Stock Inventory 0 m Tile Drain O o. Vapor Sniff Wells O os Sensor Instrument <br /> O oe Ground Water Monitoring We's O oT Pressure Test O oe Internal Inspection O o9 None <br /> OloOther Continuous electronic monitoring <br /> VIII Chemical Composition of Materials Currently or Previously Stored In Underground Containers <br /> It you checked yes to IV-F you a•e not required to complete this section <br /> 0—way 110-0 -ty CHmmMCel Do Not use Com-e•col Name (use aaot-onai Dam to,more room <br /> store0 sic),ea CAS•(it known( <br /> 001 ❑02 j <br /> 00 002 <br /> ❑01 ❑02 <br /> I <br /> Is Container located on an Agricultural Farm? O of Yes ?w No <br /> P n Fit' g(Signatur Pnone.aareaCOO° <br /> For Local Agency Use Only <br /> Are"CT RA.C lc"rr <br /> 1CO"" <br /> n <br /> CONTACT PEmEOR 1nOr1[ w/ARCA CODE <br /> INSPECTION DATE OST INSPECTIONi PERMIT APPROVAL DATE PERMIT ID. NUMBER <br /> FOR STATE USE ONLY <br /> STATE 1 O. NUMBER JACCOunt.nQ NumOcr County Numoa <br /> Dale Rece,.eo 001 O o: 003 <br /> Majors Engineering, Inc. , 100 Park Plc. , #220, San ,Ramon, Ca. 94583 <br /> 415-820-2423 <br />