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Official Registration Form • California Water Resources Control Board r+A . Hazardous Substance Storage Statement Who Must File: Each person storing hazardous substances in any under- the lank. Wastes are included. ground container must file this form no later than July 1.1984(After October Fee: For each tank registered a $10 fee must be paid, except that retail 1. 1984 and no later than January 1, 1985 for tanks used on farms). gasoline stations pay$5 per lank. Definition of Underground Containers: The law applies to 'concrete Penalties: For failure to file,the penally is$500-$5.000 per day.If you lalsily sumps. nonvaulled buried tanks or other underground containers." (Water information,you can be fined up to$20.000 for each day the information is Code section 13173) All containers, including earthen walled pits, ponds. incorrect and has not been corrected. lagoons and sumps. that are below the normal ground surface level must Confidentiality: If you have information protected by trade secret laws. register. A tank sitting on the ground is not included. Containers partially please attach a list of the information on this form that is confidential and the beneath the surface are been re Lined r unlined pits.a are and lagoons justification for Confidentiality. including specific citations of relevant statu- are covered if earth has been removed from the storage area to construct tory and case law. the facility. Normal grading is not considered construction below ground levet Multiple Containers: Fill I and II on one form and leave it blank on all the Definition of Hazardous Substance: Any substance listed in Section 6382 remaining forms. Attach all forms together securely. II you own more than of the Labor Code or in Section 25316 of the Health and Safely Cotle. This 50 tanks you can file information on computer tape. Call 916/324-1262 for Includes. gasoline. diesel fuel. all industrial solvents. pesticides. herbicides information. and fumigants. It 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 corpaahon.Indniduel or Public Agency, South San Joaquin Irrigation District &,act Addmss City gale ZIP 11011 E. Hwy 120 Manteca CA 95336 II Facility Falbldy Name - Dealer/Foreman/Supervisor South San Joaquin Irrigation District Barrett Kehl Slreel Address Nearest Cross Street 11011 E. HwV 120 Gly Counly ZIP Manteca San Joaquin 95336 Maung Address City Slate ZIP Same Phone w/area code Type of Business 209 823-3101 0 o Motor Vehicle Fuel Station NO2 Other: Irriciation District Number of Tanks al this Facility Rural Areas Townsmp Range Section 4 1 Only: III 24 Hour Emergency Contact Person Days.Name(last name mall and Phone wonea code Nights Name past name luau and Phone warder code Dispatcher 823-3101 will notify . Kehl Dis atcher 823-3101 will notifv Kehl COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Description Container Number or Ihure is nu numuM ass,gn dncl A. ®o1 Tank ❑02 Sump ❑w Lagoon, Pit or Pond ❑04 Other: 90 B. Manufacturer(if appropriate): Year of Mfg.: C. Year Installed: 1969 ❑ Unknown D. Container Capacity: 10.000 gallons ❑ Unknown E. Container Repairs: ❑of None 2o2 Unknown ❑03 Yes Year: F. Is Container currently used? ❑o1 Yes ®02 No If No, year of last use: 1972 ❑o3 Unknown G. Does the Container Store (Check One): ❑of Waste ❑w Product N/A H. Does the Container Store Motor Vehicle Euel or Waste Oil? ❑01 Yes IN 02 No If Yes, Check appropriate box(es): ❑of Unleaded ❑:2 Regular ❑o3 Premium ❑04 Diesel ❑as Waste Oil ❑os Other (Lis V Container Construction A. Thickness of Primary Containment: ❑ Gauge ❑ Inches ❑ cm 25 Unknown B. ❑o1 Vaulted (Located in an underground Vault.) 19 o2 Non-vaulted ❑03 Unknown C. ❑of Double Walled ❑o2 Single Walled ❑03 Lined ❑N Wrapped N os Unknown ❑w None D. []or Carbon Steel ❑o2 Stainless Steel 1103 Fiberglass ❑04 Polyvinyl Chloride ❑os Concrete ❑06 Aluminum ❑or Steel Clad ❑be Bronze [IN Composite ❑to Non-metallic ❑ II Earthen Walls ®12 Unknown ❑.a Other: E. ❑o1 Rubber Lined ❑o2 Alkyd Lining ❑03 Epoxy Lining ❑N Phenolic Lining ❑m Glass Lining ❑as Clay Lining ❑m Unlined E as Unknown ❑as Other: F. ❑o1 Polyethlene Wrap 0 02 Vinyl Wrapping 0 m Cathodic Protection E 04 Unknown 0 as None 0 w.Other: