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<br /> camornia Water Resources Control Board
<br /> Hazardous Substance Storage Statement
<br /> Who Must File., Each p0r50n &lonny 11W,11 tuu+ ,ub:,9aru.<,; n ;Ir y uwli•r ilia l ir,k W,isb b [ut: lr%;Udi:d
<br /> ground container must lite this form no laler than July 1. 1984(Allis Ot lotior Fee. For €,<,rh tank rrliislered a $10 lee must be paid, except that retail
<br /> 1. 1984 and no laR.'r than January 1• SJfi.t tui Links u:,ud on larnla) gasa,llnc Starlons pay $', por lank
<br /> Definition o1 underground Containers: The law applies to 'concr€:u: penalties: For la0ure to file.the penally is 5500-$5,000 per day.If y¢w falsity
<br /> sumps. nonvaulled burled lanks or otnl,;r underground conrainers (Wafer I)tnrin.rtlon. you can be: lined up to$20.000 for each day the Information is
<br /> Code section 13173) All conlarnors Includino carthon walled plTs IwWIS. inclurecr and has not been corrected
<br /> lagoons and surnps, that are below the normal yrot.lnd sur%ic;c h VI I must Confidentiality: if you havr+, information protected by trade secret laws,
<br /> register A lank sitting on the ground Is not ocklded Conbslners P=,rllally artach a list of the aitorm alion on Ih s form that Is conlldenllal and Ine
<br /> beneath the surface are Included Lined or unl nt-d pits liontls ;end I1y00lis llr,.l,t,r;lr:�,n for conbdenLat+ly. Including specific citations of relevant stalu-
<br /> are covered it earth has bi,e:n renwved fton, int: sluraye sit:.; to c onr,tlucl tory ,Ind cal;(- law
<br /> the facility Normal grading Is nut com i6i.,ri-d conslrurllon below tlrourul
<br /> levet MuEtiple Containers; Fill! and It on one form and leave it blank orf all the
<br /> ri.:ontlln,nc,l forms Attach aft forms together securely. If you own more than
<br /> Definition of Hazardous Substance: Any iuusiLw t:Ilsled u,St"Clion 0382 50 irriks you can file Intolrnallon on computer iape. Call 9161324-1262 for
<br /> of the Labor Code or 1n Section 253111 of Inc: health and Saf�,iy Codi: 1 his Inbar mat on
<br /> includes: gasoline. diesel fuel. all lnduslrial so l�c;nis pesticides, nrrhu_, r,5
<br /> and fumigants It the material must lit' carried by a rCc)Islercd hault�r .n This is not a Permit Application. Ali Undrrground Tanks will be subject fa
<br /> posed of at a hazardous waste Site.Is cwlotilvi• q1 nil c ;i'5 plesstdr d +' 1.•:IiJ.ilion Sonic Ilirls'illrflnns have already Degun programs. Check
<br /> heat or decomposition.or W(Xa d harm hurutrm 01' W-411!r.• you mint r ,{'.lr ' m, jr lur::r counh, :,uvrrnrnenl for lurcher inlnrmatton
<br /> NOTE: ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORGE.
<br /> I Owner
<br /> Name dCorppadon.Individuals FutNrC Aycrx;y}
<br /> Stockton Scavenger Assn. , Inc . r—
<br /> P
<br /> Slreel Ad�css L:rly ZIP
<br /> Navy Drive Stock n JICA 95206
<br /> II Facility
<br /> Facility Name Ut•aier/Faneman/Sc:{,ervsr,r 4
<br /> Stockton Scavenger Assn. , Inc. Dominick Mazzanti
<br /> Street Address Neared Coss Sliecr
<br /> 1240 Navy Drive S . Pershing
<br /> Cay Corrnly ZIP
<br /> Stockton , California San Joaquin 95206
<br /> Madiny Adaess Cay Stale Lip
<br /> P 0 Box 1747 Stockton CA 95201
<br /> pnolle w/area eoce Type nI_81111111-
<br /> 209
<br /> irsm-209 946-5721 01;1 Molar Vehicle Fuel Station go:Other._._Retus_e .haulin_a�_
<br /> Number or Tanks dr Irus raClhry r,wnsrrrP Fi.nrr rrr Seelron
<br /> Aura! Arcus
<br /> 9 Only: —---
<br /> III 24 Hour Emergency Contact Person
<br /> CJuy3 Name 11A$I name 6rs11 and r'hur,e w ;Ur.l I tn1.• ' r .r ii.ra n:uin�Iegll ami i'fluerr w a t o Cod,!
<br /> Mazzanti , Dominick ( 209 ) 956-5721 ISazzanti , Dominick ( 209 ) 473 -7191
<br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER
<br /> IV Description
<br /> Conralner Number IIf(here ii no nin-Dir assign ont)
<br /> A. a, Tank 0 u2 Sump ❑to lagoon. Pit or Pond D o,i Other:
<br /> 6. Manufacturer (it appropriate): ____.- ___— Year of Mtg Year installed: ___—_ R'Unknown
<br /> D. Container Capacily,.,04�11_% gallons ❑ Unknown E Container Repairs: w None ❑az Unknown ❑03 Yes Year:
<br /> F. Is Container currently used? l Yes ❑o-' No If No, year of last use: 0❑a Unknown
<br /> G. Does the Container Store (Check One) ❑of Waste d2 Product
<br /> H. Does the Container Store Motor Vehicle Fuel or Waste Oil? rn Yes AlKo If Yes. Check appropriate bones):
<br /> ❑of Unleaded 0 o2 Regular 0 I:a f re-nliurn u, Diesel ❑us Waste Oil D o, Other (List).
<br /> V Container Construction
<br /> A Thickness of Primary Containment . ._-__._.____❑ Gauge ❑ inches ❑ crrl fa1'l.Jnknown
<br /> B. ❑of Vaulted (Located in an underground Vault) ❑02 Non-vaulted 11�Fs Unknown
<br /> C. ❑u, Double Walled M111single Walled ❑rn Lined ❑a. Wrapped us Unkrzawn ❑o> None
<br /> D. ❑o1 Carbon Steel D o2 Stainless Steel ❑o3 FibergLass ❑ ,a Polyvinyl Chloride C1 o5 Concrete 0_-f, Aluminum
<br /> 5 Steel Clad ®oa Bronze ❑17, Composite ❑iri Non-metallic ❑ 11 Earthen Walls
<br /> 0 12 Unknown 0 13 Other:
<br /> E. ❑di Rubber Lined ❑02 Alkyd Lining ❑d;s Epoxy Lirnng ❑o•, Phenolic Lining ❑os Glass Lining ❑os Clay Lining
<br /> ❑o, Unlined ua Unknown r!- Other:
<br /> . 0 a, Polyethlehid Wrap P 02 vinyl W . lin# ❑o3 Cathodic Proteciion o+ Unknown 0 os Nene ❑w Other: _
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