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Official Registration Form California Water Resources Control Board Hazardous Substance Storage Statement "`V Who Must File: Each person storing hazardous substances in an under- ground container must lite This loan no later than July 1, 1984(After any the lank. Wastes are included. 1. 1984 and no later than January 1, 1985 for tanks used on farms). Fee: For each tank registered a $10 fee,must be paid, except•that retail ssumps.ion of nonvaulted buurietl tanound ksOfothe ntainer: Th ground pliescontato -- (Water gasoline stations pay$5 per tank. Code section 13173) All containers. including earthen walled pits, (Walter Penalties: For failure to file,the penalty is$500-$5,000 per tlay.If you falsify lagoons and sumps. That are below the normal ground surface level mus. information, you can be fined up to$20.000 for each day the information is register. A tank silting on the ground is not included. Containers partially Confide and y: IfnYouehaven e information protected by trade secret laws. beneath the surface are included. Lined or unlined pits,ponds and lagoons passe attacht are covered if earth has been removed from the storage area to construct Please attach a list of the information on this corm that is confidential and the the facility. Normal grading is not considered construction below ground justification for confidentiality, including specific citations of relevant slatu- level. for and case law. Definition of Hazardous Substance:Any substance listed in Section 6382 remaining rims. Attach lall forms together l I and 11 on one f securely 1eIt your blank on own more Ithan of the Labor Code or in Section 25316 of the Health and Safety Code.This 50 tanks you can file information on computer tape. Call 916/324-1262 for includes: gasoline. diesel fuel, all industrial solvents. pesticides. herbicides 50 tanks and fumigants. If 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 regulation. Some jurisdictions have already begun programs. Check heat or decomposition or would harm humans or wildlife you must register with your local county government for further information. NOTE: ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORCE. I Owner Name Icondoration.Individual or Public Attorney) South San Joaquin Irrigation District Seem AaGorss 11011 E. HWy 120 cry stale ZIP II Facility Manteca CA 95336 Fatally Name South San Jo Dealer/Foreman/Supernsor aquin Irrigation District Slreel Address Barrett Kehl 11011 E. Hwy 120 Nearest Cross Street City Manteca county ZIP viadrNAdd1e55 San Joaquin 95336 513me Illy Slate ZIP Phone w/area code TY5;dl Business ( 209 ) 823-3101 ❑or Motor Vehicle Fuel Station Sl oz Other:' Irrigation Di-tr Number of Tanks ar Ims FacAay Townsni Rural Areas g 4 Only: Ba ge section III 24 Hour Emergency Contact Person Days.Name Qdst name Inst)and Phone w/area code DiSjOdtCher 823-3101 (Will nOtlf N,gNr Name(last name elect and Phone w'arca code • Kehl Dispatcher 823-3101 will notify Kehl COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Description A. 0 on Tank ❑oz Sump ❑03 Lagoon, Pit or Pond ❑04 Other: Contamar NYmbir In there is no numberassign one) 1—D B. Manufacturer(if appropriate): Year of Mfg.: C. Year Installed: 1968-72 ❑ Unknown D. Container Capacity: 8.000 gallons ❑ Unknown E. Container Repairs: ❑oI None ®oz Unknown ❑o3 Yes Year: F. Is Container currently used? N of Yes ❑oz No If No, year of last use: ❑os Unknown G. Does the Container Store (Check One): ❑or Waste S)oz Product H. Does the Container Store Motor Vehicle Fuel or Waste Oil? Z oI Yes ❑oz No If Yes, Check appropriate box(es): ❑of Unleaded ❑oz Regular ❑o3 Premium N a Diesel ❑os Waste Oil ❑as Other(Li smik V Container Construction A. Thickness of Primary.Containment: ❑ Gauge ❑ Inches ❑ cm 29 Lrnkn"We B. ❑aI Vaulted (Located in an underground Vault.) oz Nan-vaulted ❑oat Unknown C. ❑oI Double Walled ❑az Single Walled ❑03 Lined ❑04 Wrapped )os Unk D. ❑or Carbon Steel ❑be Stainless Steel ❑03 Fiberglass ❑w Polyvinyl Chloride Aluminum ❑o, Steel Clad ❑w Bronze ❑w Composite ❑to Non-metallic ❑ It Eart 29 Iz Unknown ❑Ia Other: E. ❑of Rubber Lined ❑m Alkyd Lining ❑03 Epoxy Lining ❑w Phenolic Lining w Clay Lining ❑or Unlined S be Unknown ❑oat Other: F. ❑ol Polvethlene Wran 171rod Vinvl Wranninn r-1