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"VI Piping — <br /> A. Associated Piping: 0 0, Above Ground W2 Underground ❑a3 Vaulted <br /> B. Underground Piping: ❑of Gravity ❑02 Pressure ll s Suction ❑as Unknown <br /> C. Piping Repairs. ❑o, None ❑,,? Unknown Yr s, YcaE of mast recent repair. HS71 ' <br /> V11 Leak L)etection <br /> ❑0, V,sua6 ❑a2 Stock Inventory 0 us T,ie Drain ❑u Vapor Sniff WOS 0 un Sensor Instrument <br /> t E❑0s Ground Water Monitoring Wells er Pressure Test ❑as Internal Inspection 0:39 None <br /> E0©thee <br /> VIII Chemical Composition of Materials Currently or previously Stored In Underground Containers <br /> It you CheCked yes to IV-H you are not required to complete this section, <br /> p�aAraualY CMmicd Do Not use C:ommnrCsar Na se adLNI,lnal paper for more room) <br /> 3Sped <br /> Stott o CAS a til known) <br /> II � 11 Ilfllll - <br /> ❑02 II II I <br /> ❑o, [1 02 <br /> dot ❑02 L•LL L_Li I <br /> C3 at 002 <br /> ❑o, ❑G2 <br /> ❑0, D©2 � <br /> Doi ❑02 -I 1 I l H_1._LL1HU.__ _ ---- <br /> ❑0, ❑02 1.1L[ I L I I I I I <br /> El 01 D 02 IH <br /> ❑of 1:102 1_.1 L.1 I.._.. .1._I I Li._ <br /> [Isontainer located on an Agnrullural Farm? ❑o, Yc_s fA'ca No <br /> IX IMPOFITANTI Read instructions before signing: 111 <br /> Signature: <br /> TI-1c.form must be signed by 1)a principal execulrve officer at the level of vice-president or by an authorized representative.The representative <br /> must be respons hle for the overall Operation of the facility where thr:lank(s)are located.2)a general parinhr propnelor,or 3)a principal executive olf,cer, <br /> ranking ejected official or aulhorized repiescnlallve;of a public agency. <br /> This torts has been completed under the penally of perjury and,to the best of my knowledge, is true and correct <br /> S,gr,toe l ,Dale <br /> v fes: -- •/ _ =—'S" <br /> Pnn,uv Narnu <br /> Lib.' iTGnf!WJ dMA cWt! <br /> Sand check to: Hazardous Subslance Storage Statement, 5latc Water Resources Control Roard, PO Box 100 Sacramento, CA 95801-x7100 <br /> Pur son Finny Ssuvamrns �/ F•rune r.'nrca cage <br /> For additional`forma or more Information calf 916/324-1262 <br /> FOR STATE USE ONLY <br /> YD Number Accouns,ng Numoee County Ni mnr_r <br /> Da€ARecervea l_�i:,__..f~ ....— 002 �.. 1393 <br />