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VI Piping 40 <br /> A. Associated Piping: Out Above Ground 0 o2 Underground 0 o3 Vaulted <br /> B. Underground Piping: 0 of Gravity 0 o2 Pressure 19 w Suction 0 04 Unknown <br /> C. Piping Repairs: got None 002 Unknown 003 Yes, Year of most recent repair: <br /> VII Leak Detection <br /> 00) Visual N o2 Stock Inventory 0 o3 Tile Drain ON Vapor Sniff Wells ❑os Sensor Instrument <br /> 0 m Ground Water Monitoring Wells 0 or Pressure Test 0 m Internal Inspection 0 0s None <br /> 0 to Other: <br /> VIII Chemical Composition of Materials Currently or Previously Stored in Underground Containers <br /> II you checketl yes to IV-H you are not required to complete this section. <br /> eu.nay puNoatly Chemical Do Na Use Commercial Name fuse ae0amnal yaps lot more loom) <br /> stood It.,,,. CAS a ill known) <br /> Doi 002 <br /> Dol 002 <br /> Dor 0w <br /> Dor Do <br /> 0 o 002 <br /> Dot 002 <br /> 00) 002 <br /> D0. Got <br /> DUI 00 <br /> Our 002 <br /> D01 Dot <br /> Dot 002 <br /> [l01 D02 <br /> Is Container located on an Agricultural Farm? 0 of Yes ®u2 No <br /> IX IMPORTANT] Read instructions before signing: <br /> Signature: The form must be signed by 1)a principal executive officer at the level of vice-president or by an authorized representative.The representative <br /> must be responsible for the overall operation of the facility where the lank(s)are located.2)a general partner proprietor,or 3)a principal executive officer, <br /> ranking elected official or authorized representative of a public agency. <br /> This lorm has been completed under the penally of perjury and,to the best of my knowledge,is true and correct. <br /> signature Door <br /> 3/13/86 <br /> PnrneO Name TiIIC Phone wr arua[oU�� <br /> Barrett Kehl Manager 209 823-3101 <br /> Send check to: Hazardous Substance Storage Ament,Stale Water Resources Control Board P.O. Box 100,Sacramento.CA 95801-0100 <br /> Paean Fntng Statement --.�-.. — __.--• Yew...nm�+.w�., _ <br /> (Nos. ) C. M. Hoelscher I (209) 823-3101 <br /> For additional forms or more information call 916/3241262 <br /> FOR STATE USE ONLY <br /> iu N,enl:,.t n.tu„ril.rttl N...vo,. Cuurnr Na141r..I <br /> 64 31641 <br />