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I <br /> VI Piping <br /> A Assomaled Ppina ❑el Above Ground X1 :2 Underground ❑m Vaulted <br /> R Underground Piping. ❑or Gravity ❑u2 Pressure M m Suclion ❑c: Unknown <br /> C. Piping Repairs. ®m None ❑oz Unknown ❑oa Yes. Year of most recent repair: <br /> VII Leak Detection <br /> ❑:, Visual ❑sz Stock Inventory ❑ l Tile Drain ❑o, Vapor Snilf Wells ❑ds Sensor Instrument <br /> ❑ , Grcund Water Monitoring Wells Cloy Pressure Test ❑ internal Inspection J0 u? None <br /> ❑i. Ga�:r <br /> VIII Chemical Compos@Ion of Materials Currently or Previously Stored In Underground Containers <br /> If yon, checked yes to IV-H you are not required to complete this section. <br /> Cumm�y Pr�rlowlY CMmlul Clc Nur Use Commer6ar Name IUSC addn,onar paper ror nwre'oO l <br /> CAS I III kri.., �— <br /> Cl ❑ illllllllllll <br /> ° r _� IIIIIIIIIIIII <br /> I�. ° ° IiIIIIIIIiIII <br /> ° <br /> ° -- <br /> °__ <br /> r <br /> ° IIIIIIIIIIIII <br /> ° �_ 1111111111 . 111 __ - <br /> -• <br /> L7- ° illlllllllll <br /> ° l�_1_L11111111 <br /> _° IIIIIIIIIIIII <br /> is Container located on an Agricultural Farm? ❑or Yes dCo: No <br /> IX IMPORTANT! Read instructions before signing. <br /> SThe lorm must be signed by 1)a principal executive officer at the level of vice-president or by an authorized represenwive The rep+esentaiwe <br /> mus:be 11 ppnsrble for the overall operation of the facility where the tank(s)are located 2)a general partner proprietor,or 3)a principal executive officer. <br /> ranking electrd cific al or authorized representative of a public agency <br /> This form has Leen completed under the penalty of perjury and.to the best of my knowledge.is true and correct <br /> ome OCT 15 1986 <br /> R NBPnMC W.'area carie <br /> James F. Leonard Director _ 209) 944-2444 <br /> Send check to: Hazardous Substance Storage Statement. Slate Water Resources Control Board, P O. Box 100, Sacramento.CA 95801-0100 <br /> I <br /> Jeffrey Smith 209)) 982-5070 <br /> For additional forms or more Information call 9161324-1262 <br /> FOR STATE USE ONLY <br /> 01 <br /> \O <br /> L <br />