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VI Piping <br /> A Associated Piping. ❑o, Above Ground X102 Underground 0 0 Vaulted <br /> 8 Underground Plp:ng: ❑of Gravity ❑u2 Pressure m Suction ❑e+ Unknown <br /> C. Piping Repairs. Mo, None 0 1 Unknown 0 o Yes. Year of most recent repair: <br /> VII Leak Detection <br /> ❑m Visual Mc2 Stock Inventory ❑or,Tile Drain p w Vapor Sniff Wells ❑us Sensor Instrument I <br /> ❑r Ground Water Monitoring Wells ❑n, Pressure Test 0 os Internal Inspection ❑m None <br /> ❑Iu. Other <br /> VIII Chemical Composition of Materials Currency or Previously Stored In Underground Containers <br /> If you checked yes to IV-H you are not required to complete this section <br /> CV vprerioutly CMmlul Uo Nol Use Commerbal Name USC a4d1i0^al paper Ipr corn¢rppm.l <br /> scoreded :'.vr: CAS a III 4nowm <br /> C1 V, ❑o2 <br /> ❑al ❑u. <br /> 0 0 ❑L2 <br /> ❑01 ❑e> <br /> ❑Ur ❑p. <br /> ❑l ❑ <br /> OF <br /> ❑ .i ❑ <br /> ❑::, ❑ ,: <br /> ❑i ❑r- <br /> O m ❑ <br /> Is Container located on an Agricultural Farm? ❑m Yes Cjn2 No <br /> IX IMPORTANT! Read instructions before signing: <br /> Signature: The form must be signed by 1)a principal executive officer at the level of vice-president or by an authorized representative.The representative <br /> must be responsible for the overall operation or the facility where the lank(s)are located 2)a general partner proprietor.or 3)a principal executive officer. <br /> ranking elected official or authorized representative of a public agency <br /> This form has been completed under the penally of perjury and.to the best of my knowledge,is true and correct. <br /> ,gnaw.. Dale <br /> OCT 15 1986 <br /> nr:u wamP _ __ rnm _ pn9ne warea cove <br /> James P. Leonard Director (209) 944-2444 <br /> Send check to: Hazardous Substance Storage Statement, State Water Resources Control Board, P,O Box 100,Sacramento, CA 95801-0100 <br /> Persa+Pmnq siaier-'eni Phone w area cone <br /> Jeffrey Smith (209) 982-5070 <br /> For additional forms or more Information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> 4.,n-0e• AL[e,inUod MwnOO, - ,i n1y NJmber <br /> _.._ <br /> 24 31597 <br />