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VI Piping <br /> A. Associated Piping: ❑of Above Ground O o2 Underground ❑03 Vaulted <br /> B. Underground Piping: ❑of Gravity ❑02 Pressure 79 o3 Suction ❑04 Unknown <br /> C. Piping Repairs: ®of None ❑02 Unknown ❑03 Yes, Year of most recent repair: <br /> VII Leak Detection <br /> ❑of Visual 12202 Stock Inventory ❑03 Tile Drain ❑w Vapor Sniff Wells ❑os Sensor Instrument <br /> ❑oe Ground Water Monitoring Wells ❑m Pressure Test ❑or Internal Inspection ❑w None <br /> ❑to Other: <br /> VIII Chemical Composition of Materials Currently or Previously Stored in Underground Containers <br /> If you checketl yes to IV-H you are not required to complete this section. <br /> eortonlly pnNwuly Chemical bo Nor Use commercial Name (use additional paper for more room) <br /> stored slrned CAS 4 pl known) <br /> Doi D 0 <br /> ❑or D 0 <br /> ❑ol ❑02 <br /> ❑01 ❑02 <br /> I]or ❑02 <br /> ❑01 D 0 <br /> ❑01 ❑02 <br /> ❑01 0 <br /> I]01 D02 <br /> ❑or D 0 " <br /> Doi D 0 <br /> ❑01 0 <br /> El or D 0 <br /> Is Container located on an Agricultural Farm? Dol Yes Noe No <br /> IX IMPORTANTI 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 tank(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 form has been completed under the penalty of perjury and,to the best of my knowledge,is true and correct. <br /> Date <br /> signatwe <br /> 3/13/86 <br /> Pnnted Name Llle Phone w/area code <br /> Barrett Kehl Mana er 209 823-3101 <br /> Send check to: Hazardous Substance StorageStatement.State Water Resources Control Board,P.O.Box-100.Sacramento.CA 95801-0100 <br /> Person Famg statement Pnone wir ees cone <br /> (Mrs. ) C. M. Hoelsch= (209) 823-3101 <br /> s <br /> J <br /> For additional forms or more information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> to Numbme:nnny Number Counly Numbm <br /> Dam ecu+vad ❑01 O U2 ❑03 <br /> 84 316W <br />