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T Official Registration Form Califomia Water Resources Control Board - us Substance Storage a Statement 9 Who Must File: Each person storing hazardous substances in any under- the tank.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 tank. Definition of Underground Containers: The law applies to "concrete Penalties: For failure to file.the penalty is$50045,000 per day.If you falsify sumps, nonvaulted buried tanks or other underground containers." (Water information,you can be lined 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 silting 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 included Lined or unlined pots,ponds 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 Multiple Containers: Fill I and II on one form and leave it blank on all the Level remaining forms. Attach all forms together securely. If you own more than Definition of Hazardous Substance: Any substance listed in Section 6382 50 tanks you can file information on computer tape. Call 916/324-1262 for of the Labor Code or in Section 25316 of the Health and Safely Code.This information. includes: gasoline, diesel fuel, ail industrial solvents, pesticides, herbicides This Is not a Permit Application. All Underground Tanks will be subject to and fumigants. I) the material must be carried by a registered hauler, dis- local regulation. Some urisdictions have already begun programs. Check posed of at a hazardous waste site,is explosive,generates pressure due to g l 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 lCorporanon Individual or Punlld Agency) South San Joaquin Irrigation District Street Address Cdy =CA95336 11011 E . Hwy 120 Manteca II Facility Facday Name Foremanl5uperws©r t rBarrett South San Joaquin Irrigation DistricKehl st Cross Sareel $tree).Atltlress 11011 E. Hwy 120 reah' C 1y ca�rnr LP Manteca © San Ja uin 953315_ Mailing Address Cdy �o:,m ZIP S acne Phone wlarea code Type of Business 2 0 9 823-3101 Elof Motor Vehicle Fuel Station IN 02 Other: Irriation District Numner or Tanks al This Facney :OnlyAreas Tpwnshop Range Section � Only: III 24 Hour Emergency Contact Person Days Name past name Issll and Pnul is c: .—c,code rY r to Niynrs Name past name hrslj arx7 Phone w.area cane _ Dispatcher 823-3101 (will notify Mgr. Kehl) Dispatcher 823-3101 (will notify Mgr. Kehl.) COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Description Container Numtrer ill lnure s no number assign ono) A. ®of Tank ®02 Sump ❑03 Lagoon, Pit or Pond ❑03 Other: 1_g B. Manufacturer (if appropriate): Year of Mfg.: C. Year Installed: 1968-1972 ❑ Unknown D. Container Capacity:10.000 gallons ❑ Unknown E. Container Repairs: ❑or None N 02 Unknown ❑o3 Yes Year: F. Is Container currently used? 29 01 Yes ❑02 No If No, year of last use: ❑03 Unknown G. Does the Container Store (Check One): ❑of Waste tR 62 Product H. Does the Container Store Motor Vehicle FQel or Waste Oil? 0 01 Yes ❑02 No it Yes, Check appropriate box(es): [Sot Unleaded ❑o2 Regular ❑03 Premium ❑04 Diesel ❑os Waste Oil ❑o6 Other(List V Container Construction A. Thickness of Primary Containment: ❑ Gauge ❑ inches ❑ cm ;M Unknown B. ❑of Vaulted (Located in an underground 'vault) 302 Non-vaunted ❑o3 Unknown C. Dor Double Walled ❑02 Single Walled El o3 Lined ❑04 Wrapped '2 05 Unknown ❑06 None D. ❑of Carbon Steel ❑o2 Stainless Steel ❑03 Fiberglass ❑04 Polyvinyl Chloride ❑os Concrete ❑o6 Aluminum D m Steel Clad ❑oa Bronze ❑os Composite ❑to Non-metallic ❑ 11 Earthen Walls 0 12 Unknown ❑13 Other: E, ❑o1 Rubber tined ❑u2 Alkyd Lining ❑63 Epoxy Lining ❑o4 Phenolic Lining ❑a5 Glass Lining ❑D6 Clay Lining ❑oT Unlined ®ce Unknown ❑06 Other: F. ❑o1 Polyethlene Wrap ®02 Vinyl Wrapping 0 o:i Cathodic Protection S o4 Unknown 0 o5 None ❑u9 Other: