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.., . 711 OU -� Official R('41slraflon Fol 1� California Water Resources Control Hoard Hazardous Substance Storage Statement �,;�. � Who Must File: Each person stanng har+rdous substancestin any unller- Il lannrVV,'lch lank rnglst rr�d a $10 Icu must be paid. except ilial rel2ii ground commner mus! Ile IMIS Corm nu lidur Thin July 1, 198.1 Aller 0(:Wbel Fee: e:I ;talions pay$5 por lank 1. 1984 and no lalr'z Than Janualy I- 141115 for tanks used on 1£5 afmsconcictc; Detinilion or Underground Containers: The law app Penalties: For failure to We,Ire penalty is$500--$5.000 per aay.II you lalsily sumpsnonvaulled burled links or other uncterrjiound contaoers (Wnit.r informnlion you can be fined up to$20.000 lot each day the intermat:on Is Code section 13173) Ali conla ners Including earlhen walled plls, pnr,dy.. inConecl wid has not been conected lagoons and surrrps. Thal are below Inc Iwlnral ground sur}ace level must Confidentiality: J you have, mlormatoon protected by trade secrell laws. register A tank silting can Ire ground Is nol Included GonloineiS parlially t 1c,,3 rs atlach a list of tie information on this iorrn that Is conhdenfial and the beneath the surface are Included. Lined or unlined pits. ponds and h(ji)or15 ll,s,tncctrltun lot conhde'nh=rlrly. Including speclllc citations of relevant statu- are covered 11 earth has been removetl boor IIIU sturagu area to Cur;,Ilu" tnry xid ca°;r i,twr the lacility Normal gradtng is ncrl cunsidowd construction below gIOUT11!l Multiple Containers: fill I and II on one form and leave It blank on all Ine levet IOniaining Inrrns Allach all forms together securely. If you own more than Definition of Hazardous Substance: Any substance lisled,n SI;cIIun fa 1132 50 tanks you Can hle lnlormallon on compuler lope. Call 916/324.1262 lot of the Laoor Code or in Section 25316 of Me Hl aiih and Sarcty Codd This Information includes gasoline. diesel ILLI. all induslrlot s0vertls p+rslicidrs, hi'01 (les This is not a Permit Application. All Undwground Tanks will be subject to and fumigants 11 the Inalerial must be (:armed by a re:gosle-A hault`I dl., local loqufallon Somu jurlsov--lmnS have already begun programs Check posed of at a hazardous wade site.IS trxl pe:nerales prossuru 111.11r Isi tNrlh yow local county government for lurlher inlarmaltdn heal or decomposilion or would lhllrtlan� Wwlldlllc you mull rt gislur NOTE: ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORCE. I Owner Name ICapnrahon Ind.cI lal a Publ,c A9encyi COY SI18er Address 7r``IIII– II Facility I teller/Foreman!Supra V,Sor FacY,iy Name Ncalv.t Crass Strat,N Sueei Adskess Cay G,i,nly ZIP r;,ly Slate ZIP Mad,ng AOrYess Phone.!area code T-1 we nI aus,news ❑lil Motor Vehicle Fuel Station Do.,Other: al Number bI Tants al IN-',IN-',radady RurAreas lunr,;lu{r li'"r"1' $eCUun Only; III 24 Hour Emergency Contact Person rays Name(last name Insii ani 1 rn ne wawa,Udr! rJnrSe nasi tldrnC.hi5lj.,n,1 Phoro w arra crnh` COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Description TC-1-1— Number 111 Itioe,5no number a*s,gn onel A. Tank ❑o2 Sump ❑to Lagoon. Pit or Pond 0u- Other �__�___.----._.__— B. Manufacturer (if appropriate): Year of Mlg.: _ C. Year Installed: — - nknown D. Container Capacity:-�'-L'-O gallons ❑ Unknown E. Container Repairs al<None 0 02 Unknown 0 03 Yes Year: — F. Is Container currently used? ❑of Yes lz No 11 Net, year of last use: Ma Unknown G. Does the Container Store (Cizea One): ❑of Waste t2 Product H. Does the Container Store Motor Vehicle Fuel or Waste Oil? 0 w No It Yes, Check appropriate hax(es): ❑of Unleaded ❑02 Regular 0 u3 Premium ; Diesel 0 us Waste Oil ❑os Other (List): V Container Construction A. Thickness of Primary Containment _._.__._.._.._❑ Gttmgl; ❑ Inchrs D cm nknown B. 0 o, Vaulted (Located In an underground Vault.} 0 o: Non-vaulted R-r-tfrfknown C. 0 ai Double Walled ❑w Bangle Wailed ❑e, Lined 0 to Wrapped P-t75Unknown 0 o6 None D. ❑of Carbon Steel ❑n2 Stainless Steel D o3 Fiberglass ❑u, Polyvinyl Chloride ❑os Concrete 0,x,Aluminum l2tr1f—eel Clad ❑ors Bronze ❑rn Composite ❑ iu Non-metallic ❑ 1, Earthen Walls 0 1? Unknown 0 r3 Other: E. 0 oa Rubber Lined ❑P2 Alkyd Lining ❑o3 Epoxy Lining Do. Phenolic Lining Dos Glass Lining 0 oc Clay Lining ❑o* Unlined o Unknown Djoill