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1 Ncjai rleglsiranon rorm Calllonkk,�dyater Resources Control Board let Hazardous Substance Storage Statement I—W Who Must File: Each person storing hazardous substances in any under- the lank.Wastes are Included. ground ccalamer must tile this form no later than July 1, 1984(Aller October Fee: For each tank registered a $10 lee must be paid. except that retail 1. 1984 and no later than January 1, 1985 lot tanks used on farms(. gasoline stations pay E5 per lank Definition of Underground Containers: The law applies to "concrete Penalties:For failure to tile.the penally is 550045.000 per day If you falsity sumps. nonvaulled buried tanks or other underground containers." (Water inlormallon.you can be lined up to$20000 for each day the Information is Code section 13173) All containers, including earthen walled pits, ponds, incorrect and has not been collected lagoons and sumps.that are below the normal ground surface level must Confidentiality: 11 you have Inlotmatlon protected by trade secret laws. register. A lank silting on the ground is not included. Containers partially please attach a list of Ina information on This Corm that is confidential and the beneath the surface are included. Lined or unlined pits,ponds and lagoons pleasejuslilicaon for list of he alily,infor including Specific for that is c of relevant d lu- the are covered it earth has been removed from the storage area to construct jury and case law. the facility. Normal grading is not considered construction below ground level. ' Multiple Containers: Fill I and TI on one term and leave it blank on all the Definition of Hazardous Substance: Any substance listed in Section 6382 remaining forms Attach all loans together securely. 11 you own more Than of the Labor Code or in Section 25316 of the Health and Safely Code.This 50 ranks you can file Information on computer lape Call 916/3241262 for includes: gasoline. diesel fuel, all industrial solvents. pesticides. herbicides information and fumigants. 11 the material must be carried by a registered hauler, dis. This Is not a Permit Application. All Underground Tanks will be subject to posed of at a hazardous waste site.Is explosive,generates pressure due to local rugutabon Sonic jurisdictions have already begun programs Check heal or decomposition or would harm humans or wildlife you must register with your local county government jot former Information NOTE: ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORCE. I Owner Name(cormatmn.Inbwaual of Pub4e Agency) UNION CARBIDE CORPORATION S.'aCpSued Address City 0 6817Old Ridgebury Road Danbury II Facility Faal4y Name Ucalc/Fpeman/SuM'rnsor Union Carbide Ag Products Co., Inc. Vince R. Parman affect Adbesa Nnamsl Cross spent 10144 E. French Camp Road I Austin Road Cxy Looney ZIP Manteca, CA. San Joaquin 95336 Meets Address City Slam ZIP R.R. #1 Box 10144 Manteca CA 95336 Pnmd./area cane Typo ol Ousinns 209 982-1031 OrnMotor Vehicle Fuel Station I$ua ORter.'Besearch_Farm Number a Tanks at this Facarp I Rural Am&$ Tawny"P ria'"r^ snckm 3 only: III 24 Hour Emergency Contact Person days Name Itasl name Wso and Phone w/mea code N.yms eidmr Roel ntmr 1.111.dna Primo w mita cmc V.R. Parman 209 982-1031 V.R. Parman (20"23-5574 COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER HAZARDOUS WASTE TANK IV Descrlptlon Container Numher al in,nr n Id n„u m, n.Y.,yn ur.'I A. Ila, Tank ❑0a Sump ❑as Lagoon, Pit or Pond ❑all Other: 3 B. Manufacturer(it appropriate): Year of Mfg: C. Year Installed: ❑ Unknown D. Container Capacity: 1250 gallons ❑ Unknown E. Container Repairs:X7 0l None ❑02 Unknown ❑to Yes Year: F. Is Container currently used? t of Yes ❑or No II No, year of Iasi use: ❑oy Unknown G. Does the Container Store(Check One): (Kai Waste 0 o Product H. Does the Container Store Motor Vehicle Fuel or Waste Oil? ❑at Yes v`+ o2 No If Yes, Check appropriate box(es): ❑of Unleaded ❑w Regular ❑w Premum ❑04 Diesel ❑m Waste Oil ❑as Other(List):--- V List): _V Container Construction A. Thickness of Primary Containment: 3/16 ❑ Gauge M Inches ❑ cm ❑ Unknown B. D at Vaulted(Located in an underground Vault.) Etna Non-vaulted ❑dd Unknown -- C. ❑of Double Walled IM 02 Single Waited ❑03 Lined ❑04 Wrapped ❑as Unknown ❑he None D. ❑at Carbon Steel ❑da Stainless Steel ❑(oa Fiberglass ❑o. Polyvinyl Chloride ❑as Concrete ❑os Aluminum ❑oy Steel Clad ❑ne Bronze C3 os Composite ❑to Non-metallic Cl II Earthen Walls ❑12 Unknown ❑13 Other, E. O of Rubber Lined ❑oa Alkyd Lining ❑o3 Epoxy Lining ❑as Phenolic Lining ❑us Glass Lining ❑ae Clay Lining IN a,Unlined ❑as Unknown ❑oa Other: IF. ❑01 Polyethlene Wrap 0oa Vinyl Wrapping 003 Cathodic Protection ❑04 Unknown [Y.i5 None 0Ill Other: _